The Ups and Downs of Estrogen. Part 1: Estrogen Deficiency

woman low estrogenEstrogen builds bone, strengthens muscle, slows aging, raises libido, enhances insulin sensitivity, and boosts serotonin (which is why estrogen is so important for mood and sleep).

And those are just a few of the hormone’s many benefits. Estrogen regulates over a thousand genes, so it’s arguably one of our most influential and important hormones.

No wonder it feels so bad to have estrogen deficiency. (It also feels bad to have estrogen excess. Read Part 2: Estrogen Excess.)

Estrogen deficiency causes fatigue, weight gain, hair loss, depression, and terrible insomnia. It also causes dry skin, recurrent bladder infections, and the most characteristic of all estrogen deficiency symptoms: vaginal dryness. (If you were my patient, I would ask you about dryness to figure out how estrogen deficient you are.)

How to boost estrogen

There’s no one way to boost estrogen. It all depends on why it’s low. Let’s look at four common scenarios.

Scenario 1. You don’t ovulate but you’re not menopausal.

Ovulation is how you make estradiol, your strongest and best estrogen. So your big question is: “Can you still ovulate?”

You can ovulate if you are younger than 45 and your FSH is less than 25 IU/L. That’s true even if you’ve had a partial hysterectomy (uterus removed). If you have ovaries, you can ovulate.

Treatment: Figure out why you don’t ovulate. Do you have PCOS? Are you eating enough? (For a full discussion of obstacles to ovulation, read Chapter 7 of my book Period Repair Manual.)

Once you identify your obstacle to ovulation, then correct that obstacle your estradiol will rise dramatically. That’s all you need to do. (You do not need to “boost” estrogen–it will do its own boosting.)

👉Hormonal birth control is not a solution. The pill stops ovulation and completely shuts down estradiol. It replaces it with a synthetic estrogen called ethinylestradiol, which is similar to estradiol, but not identical. Ethinylestradiol is not as beneficial as your own estradiol and it’s combined with progestin drug that can cause depression and hair loss.

Scenario 2. You do ovulate.

If you ovulate, then you have sufficient estradiol. Why? Because if you did not, then you would not be able to reach ovulation.

👉 Tip: It’s normal to have very low estradiol early in your follicular phase (even within “menopausal” reference range).

If you have light scanty periods (but you ovulate), then you may have slightly lower than average estradiol. I call this relative estrogen deficiency.

Treatment: Relative estrogen deficiency can occur at any age, and can be the result of smoking, undereating, stress, vegetarian diet, gluten sensitivity, or eating too much soy. Your best treatment is to correct that underlying problem.

Scenario 3. You’re having an easy menopause transition.

Your ovaries make less estrogen after menopause but the rest of your body can pick up the slack by converting an adrenal hormone called DHEA into estrogen. To be able to do that, you need a good supply of DHEA, which is why it’s so important to support your HPA (adrenal) axis function during the menopause transition. And over time, your body will adjust to your new normal lower level of estrogen.

Treatment: Read Rescue Prescription for Menopause and Perimenopause.

Scenario 4. You’re having a difficult menopause transition.

If you’re reading this section, then you know the hell that can come from a sudden and severe drop in estrogen. A difficult menopause transition can happen after a total hysterectomy (ovaries removed), or suddenly stopping hormonal birth control or hormone replacement.

Severe estrogen deficiency can cause hot flashes, depression, and terrible insomnia. I’ve witnessed these symptoms with many patients, and I really don’t think any woman should have to put up with them. That’s why I support the use of a body-identical estrogen such as an estradiol patch like Estradot. Estrogen works best when used together with a micronized or natural progesterone capsule such as Prometrium (even if you don’t have a uterus). Read Rescue Prescription for Menopause and Perimenopause.

In summary, estradiol is a luscious, life-giving, essential hormone. Before menopause, you make estrogen with your ovaries and you can only do that if you ovulate regularly. After menopause, you make estrogen from your adrenal hormone DHEA.

Read The Ups and Downs of Estrogen. Part 2: Estrogen Excess.

221 thoughts on “The Ups and Downs of Estrogen. Part 1: Estrogen Deficiency”

  1. Your unsub links on the “notify me of new comments” email do not work for me. I do not want to get any more comments, but I have no way to do that automatically. Please take me off the list for getting notices of comments. Thanks.

  2. I gad a hysterectomy 3 years ago .Have not been right ever since . Irregular hart Beats Tired all the time can’t think Depression bad. I wished i never had the opp its destroyed me completely mentally viability. I have been to so many doctor’s and its cost me fortune. I am on the patch and cream only 1mg . I know i need more than that . Please help me .us there an injections i can have .Feel like giving up at times .That how bad it is .

  3. Lara – what are your thoughts on supplementing with Flaxseed to help raise Estrogen? I’ve read conflicting information that flaxseed blocks estrogen too (my levels are very low) Many thanks

    • Flax blocks estrogen but at the same time, flax can help to promote ovulation, which is how you make estrogen. If your levels are very low, it’s because you’re not ovulating. Are you eating enough to be able to ovulate?

  4. Laura – I found your article interesting and am very interested in reading your book. I’m 37 and have suffered from fatigue and weight gain (35 pounds over the past 3 years) as well as increased mood swings, sweating and anxiety over the past few years. When this started I was having irregular periods (skip 1 or 2 months then have multiple cycles in the same month etc.). My doctor put me on a birth control pill and 20mg of citalopram. At first, on the birth control my cycle became regular for a few months and then stopped all together. I haven’t had a period in over 2 years. My mood swings have definitely improved but I hate feeling dependent on medication to feel somewhat “normal.” Although I have made dietary changes and exercise regularly (although not nearly at the level that I was) – I can’t seem to lose weight and can’t seem to get back to “feeling like myself.” I asked my doctor if I could be going through early menopause – and she was adamant that I wasn’t. At my insistence, she tested TSH and FSH – and those levels came back in the normal range. I can’t help but feel that something is going on and that it is hormone related. Additionally, I have had a lot of issues with TMJ that my dentist seems to think could be hormone related – ? 4 years ago I was running half marathons and now I feel like a different person (not in a good way) or at least like I have someone else’s body. Could this be hormone related despite tests coming back “normal”? – are there other tests I should look into? Grateful for any advice.

  5. Hi, Lara.

    Thanks for all the information you give us. I’ve got a doubt about ashwagandha. In your book you recommend to take it twice daily but what about timing? At breakfast and dinner? Or would it be better to take both doses before afternoon?

    Thanks 🙂

  6. I am one of those with relative estrogen deficiency, been always like that due to higher male hormones since a baby. I am planning on getting pregnent and would like to know what my estrogen and progesterone levels are doing during my menstrual cycle. Are cycle mapping tests recommended? The tests start to be available for purchase (urine or saliva).

    https://dutchtest.com/product/dutch-cycle-mapping-female-only/
    https://canaryclub.org/home-diagnostic-tests/focused-test-profiles/focused-tests/menstrual-cycle-mapping

    Thank you

  7. Hi Lara,

    Im 42 years old and for the past few months ive been feeling miserable, lack of good quality sleep, extreme mood swings, hot flashes and my periods are very regular 28/29 days but once 5 days one they are now short and very light, just 2 days at most. What might be wrong, im guessing im having low estrogen…and i also have a lot of digestive issues and a little bit insulin resistance. What might help me ? Can i take maca (maca harmony femmemessence) and what about d chiro inositol ?

    thanks

    warm regards

    Catarina

  8. Hi most likely I am estrogen deficient and I already am on 200 mg of progesterone and use testosterone topical once weekly
    I am symptomatic but estradiol is below 50. It is 47. Most likely gonna start on estrogen cream or a patch. I have heard that patches release alot more hormones at first then level out. Is it a better idea to use compounded cream if my clinician will start it. I also have hashimotos disease I have heard that that my thyroid meds will need to be altered as well. Is that true? Thanks. Patti

  9. Hello:
    Awful reaction to estrogen cream!!
    Two nights ago, for 1st time every, I applied EstroGel .06% to my inner arm & then rubbed that arm to inner thigh. The amount was about 20%–or less– of a ‘squirt’ that comes out from the dispenser. (My gynecologist wanted me to use 50% of a squirt!)
    The next morning, my face looked as if it had been bee-stung and I was dazed ‘n confused, literally as if on a drug . I won’t touch the stuff now.
    Oddly enough, I’ve used the estrogen-based vaginal cream (.01%) about 3 x– twice per 7 days– during last 12 months. Thankfully I’ve had zero negative reaction to the vaginal cream :)) I am 15 years into menopause & live with insomnia, growing depression (lack of sleep ‘helps’) as well as chronic fatigue, hypo-thyroid condition. Greatly appreciate your input Dr. Lara.

  10. Hi Dr. i’m 55 and had irregular periods still and they have been very scanty for at least 3 yrs or more, like spotting, but i still had them even though the length of them could be long. Started hot flashes/night sweats, insomnia, doc put me on synthetics. Immediately stopped hot flashes/night sweats and shot my libido through the roof which i LOVED of course but just about drove me to the brink emotionally (i have bipolar) they just about killed me.

    A pharmacist urged me to at least get off Progestin (medroxyprogesterone) and onto natural prog. cream. i did about 1/4 t twice daily and the difference in mood is night and day, it saved me. I dropped the 1 mg Estradiol and i don’t know if i should still be taking it?? I don’t want to lose the sex drive (my testosterone levels are fine) and i do have vaginal dryness and some atrophy. The constant very light spotting immediately stopped on natural progesterone cream. i do have a natural Estriol/Estradiol cream. I obviously was not in menopause yet because i was still bleeding.

    I have no idea if i have estrogen dominance or deficiency or just need natural progesterone!! i feel a bit bloated and slightly heavy breasts on natural progesterone but i don’t want to over do estrogen so i don’t have a clue 🙁 Thanks so much for ANY comments!

      • i just read it, thank you!! i do take magnesium but recently added Taurine (not enough, according to your article). i have vaginal atrophy even during that 6 months of Estradiol 1 mg ..the entrance and first 1/4 of the vagina gets very sore after sex (burning) even with using a lot of good quality lube.

        i am wondering if i can take my estrogen cream and just rub a tiny bit there–it does make it burn a little. i was also afraid of losing my libido (testosterone is in good range) Maybe i just need to give the natural progesterone cream more time to work as i have learned from your site that Progestin is NOT progesterone so maybe i’m really deficient after all!!???

        Thanks for your replies, i am forwarding your site to my friends.

  11. Hi Lara, can taking bioidentical progesterone cause a deficiency in estrogen? My estrogen was low before I started taking Progesterone but I’ve recently started having more low estrogen like symptoms and I can’t figure out if it’s thyroid related or an estrogen deficiency.

    • I’m going to say no, natural progesterone used correctly shouldn’t deplete estrogen. But, high dose progesterone taken at the wrong time of the cycle can suppress ovulation and that would cause estrogen deficiency. It all comes back to ovulation.

        • Of course, it all depends on your unique situation and the doctor’s strategy. I generally do not recommend progesterone in the follicular phase because it can suppress ovulation. BUT it is sometimes necessary for severe symptoms such as endometriosis and perimenopausal flooding periods.

  12. Hi Lara,
    There is a lot of info, including in your book, about irregular spotting in the luteal phase, but I’m just wondering what might be the cause of light bleeding after a period, beginning day 9-10? Does this necessarily relate to a drop in estrogen? I ovulate and have regular periods (28-29 day cycles), and have had 21-day progesterone tested as normal (32.3 mmol/L). I had ovulation spotting once in the past, but this type of thing has never happened before. I wouldn’t call it spotting, not as heavy as a period but it’s brown (with some red), kind of mucousy bleeding. I’m day 14 today and seems like it could be tapering off. Any ideas? Could stress cause this? Thanks!

    • Is this something that’s happened a few cycles or only once? If it’s just a one-time thing, then yes, it could be stress and lower than normal estrogen. Maybe watch to see if you do actually ovulate this cycle (you can track temperatures).

      If it happens again, you might want to check with your doctor to rule out other things like uterine polyps etc.

      • Thanks for your reply, Lara. Yes, this is the first time this has happened. I had particularly bad PMS at the onset of my last period (it’s usually low-moderate level PMS), so I am wondering whether the two things are connected? I didn’t track my temp (it’s day 16 now), but usually I can tell I have ovulated as I will have tender breasts for a few days afterwards. Haven’t got that yet. Although, that symptom was rather delayed after the last ovulation (still 28 day cycle though). I started taking magnesium about a week ago so hope I can get on top of this for future cycles.

        • It’s possible you’re going to have an anovulatory cycle (from stress), which could explain the spotting. But like I said, if it keeps happening, you should check with your doctor.

  13. Hi Lara, is vaginal dryness only a symptom of low estrogen? I’m 37 and recently I got stuck in a vicious cycle of vaginal dryness causing yeast infections, treated by antifungal cream and suppositories which damaged my vaginal flora (and the cycle starts again every month if I have intercourse with vaginal dryness). I thought I had low progesterone symptoms last year (shorter cycles, spotting etc.) and followed your advice which seemed to help a lot. But is it possible to have both low progesterone and low estrogen?? What do you advise to break the cycle of vaginal dryness causing yeast infection? Many thanks

    • Is the dryness only at a certain time of your cycle? Say, just before your period? You’re not on any kind of hormonal birth control, are you? (I’m assuming not because you mentioned shorter cycles.)

      • yes I don’t take hormonal birth control, I use the natural fertility method. The dryness happens especially in the second part of my cycle (a few days after ovulation up until my period). But I think I’m generally “drier” than I used to be.

  14. Hi Lara. Just wondering about whether there is an alternative to the pill to maintain bone density for women who cannot ovulate. I’ve had hypothalamic amenorrhea for 8 years (since my mid twenties, I’m now 32). When I lost my periods I was running a lot and undereating carbs, but now I eat lots and exercise moderately. I’ve been on and off the pill over the past 8 years, but last came off it 8 months ago and have symptoms of estrogen deficiency. My gyno can’t explain why I don’t ovulate but says it’s not important. He strongly recommends that I go on the pill for my bones until I want to have a baby and then he says they can induce ovulation. I don’t want to take the pill but I’m also worried about bone density as all the older women in my family have osteoporosis. I should also mention that my gyno is pretty certain I don’t have PCOS or early menopause from my blood tests and ultrasound. I’ve read your book and can’t figure out why I’m not ovulating so I’m seriously considering the pill again, but wondering if estrogen creams could also help my bones? Thank you for this great blog!

  15. Hi Lara,

    Is estrogen supplementation good? Especially for treating insulin resistance PCOS (high testosterone, lots of facial hair)?
    Thank you very much for your work!!
    Hugs,
    J.

    • Hi Julia,

      No, I can’t see that an estrogen supplement will do much for insulin-resistant PCOS (despite the fact that Yes, estrogen is helpful for insulin sensitivity). Because PCOS is part of the first scenario: A woman who can ovulate.
      So the #1 strategy is to promote ovulation by reversing insulin resistance. That’s done by quitting sugar (all sugar, including natural sugar). Please see my posts Why I Ask Some Patients to Quit Sugar and also The 7 Best Anti-Androgen Supplements.

  16. I don’t understand why you don’t have anything to suggest for those of us who are postmenopausal. At 70, I continue to have hormone concerns. Thanks.

    • The main hormone after menopause is the adrenal hormone DHEA which is a precursor to estrogen. That’s why herbal medicines that support DHEA–such as ashwagandha–can be helpful. (And which I discuss in the article.)

          • Oh interesting. I’m in the US and its readily availablf over the counter here.

            Lara can you still advice if taking micronized DHEA (if not banned) is a good idea? Thanks.

          • DHEA is not banned in Australia. It’s a prescription item. But my understanding is that individuals can import it for personal use.
            I don’t routinely recommend it. But I have just learned of an over-the-counter DHEA vulva cream which sounds promising for some symptoms.

  17. Dear Lara,
    Thank you for your great articles, they answered a lot of my questions. I also come from ordering your book. To Germany! 😉 I had to order it via British Amazon to get it. Really tricky.
    I am, unfortunately very young because my body had to cope with loads of stress, which reduced my progesterone early 🙁 , in menopausal transition and suffer extreme vaginal dryness. It’s almost as dry as my normal skin! I have an Estriol creme for it (I apply it on the inner leg skin, not in the vagina).
    You write in your blog above about an Estradiol creme, not an Estriol creme. Which confuses me. Because in Germany I was told by the best specialists we have (you explained to me a lot they don’t seem to know), that Estriol is the “mucosa humidity hormon”. They never do an estradiol supplement, but progesterone and estriol. Also in respect that, they say, Estriol is the biggest part of Estrogens and should stay it. By an estradiol supplement, they say, Estradiol becomes extremely dominant vs. Estriol and that also might lead to cancer.
    What is your opinion about Estriol? And what can I do best for my vagina’s humidity?
    PS: Oh, my specialists say, only if you apply a very big amount of Estradiol a part of it will be restructured by the body to Estriol. But then Estradiol is much too much. So better apply Estriol.

  18. Hi Laura!
    Thank you for this valuable information. My midwife friend just recommended that I take a look at your site. I am looking forward to reading more on this site and checking into your book. I am 37yr and have not had my period for the last 3yrs. At the time this started I went vegan, had stress in move and relationship, and started to develop rosacea on my face, heart palpitations, and brain fog. Since then my skin is a lot better and I do not have the brain fog and little heart palpitations. I have begun to eat more fish and am trying to work up to eating some red meat. I sleep well and fell fairly healthy. My recent blood test shows that my estradiol is <15 and progesterone is .5. Because I do not bleed I do not know what phase i am in my cycle, but will be begin to take my temperature to see if I can detect ovulation. With this little amount of information do you have any advice and support to offer on how I can balance my hormones so that I can begin to bleed again as I would LOVE to have a baby in this life if at all possible! Thank you for any guidance.

    • A vegan diet can impair ovulation. I’m just about to release my new book, which has a whole chapter about lack of periods.

  19. Hi Lara

    Thank you for your helpful information.
    My estradiol levels are very low since I first took a blood test 5 years ago. I was then 34. I tried all the supplements I can think of…maca, vitex, black cohosh…with little luck.
    I am now 39 and most of the time my range of estradiol is 20-35pg/ml. Only once the measuring was 45pg/ml.
    6 month ago I also had low progesterone and FSH 11.
    I started acupuncture and it helped my FSH and progesterone levels, but my estradiol is still 26pg/ml. I am having a normal period 24-28 days, but I suffer from 2-3 days menstual migraines and I remember I suffer from them even before I first measured my estradiol levels, so maybe I was deficient even longer.
    I am scared to take HRT and I am also scared that my bones will suffer.
    I wanted to ask what are the estradiol levels that need HRT. I though of continuing acupuncture and other supplements I take but if t is really necessary I am considering to take HRT because I am scared of the bone diseases. My mother is suffering from arthritis from her 40s.
    I would appreciate your view on this.

    Thank you

    Kind regards

    Niki

  20. Thank you so much for all your hard work putting all this together for us…I’m so lost..: I’m 48, haven’t had my period for 8 months, and was on a Rollercoaster ride since 41 so I’m assuming I might be in menopause..i took bioidentical progesterone cream starting a year ago and I felt amazing for a couple of months and it tapered off to making me feel extremely depressed and extremely fatigued..gained 30 lbs in a year…..finally stopped the cream..each time I try to take it now I’m very tired and low next day…I tried adding estriol , little on my face and some vaginally to boost a non existent libido and painful being with my husband ,..it has helped with the vaginal dryness and pain but leaves me tired and low the next day..my blood work showed very low estrogen and progesterone and slightly low testosterone..intake vit.d and a good Natural vitamin from garden of life…so I’m spending my life hungry tired and depressed, no sexdrive, motivation ..i don’t understand why I feel best when I don’t take any hormones but blood work shows very low and all the symptoms are there…I tried taking Dr Wrays advice and use 100 to 200 of progesterone a day and I was about ready to kill myself during that time…any advice ? I’m departed to get some energy for life back and be able to be with my husband, not to mention lose the weight…thank you so much for all your dedication for us women..

    • anni, i’m about in the same boat but iwth a much longer complex case. i followed Dr. Wray’s advise too and did not help. I am reeking of Progesterone body odor…telling me i’ve OD’d on P. i’m trying to sort it out too . i’m also 48 – no period for almost 3 yrs.

  21. Hi Lara

    I have a bit of a conundrum: I started taking soy isoflavones in a bone support supplement and it shortened my cycles from 30-40 days to 27-28 days, also i had ovulatory spotting and TERRIBLE breast tenderness. I didn’t I know what was going on (I thought I might be pregnant a few times due to the sudden change in PMS symptoms). Now I’ve realised what was causing the breast tenderness so I’ve stopped the supplement but my most recent ovulation has been late and stuttering, my acne has flared up and I’m feeling very emotional. I struggle to ovulate usually and so the isoflavones have helped with that, but I don’t want to take supplements unnecessarily, especially if there is an increased cancer risk and massively painful breasts!

    Could I take the isoflavones for a couple of days before ovulation to boost estrogen? Its odd that you mention soy suppressing hormones but it seems to have boosted mine?

    Thanks for any insight you can give.

  22. Dr Lara Briden, in my comment to another post, you had said that topical (not vaginal) estriol is safe for estrogen deficiency in perimenopause. Would you say that 1.5 mg estriol cream applied daily to skin is safe? Estriol creams are sold OTC in US. Thanks

  23. Hi Lara, I have stumbled upon your website which I find magnificent and very informative, as I have been looking for answers: I noticed since some three months that I am losing hair, recently even more so. I am 39 years old (this year 40) and also my periods are becoming lighter and lighter. I have been using Nuvaring for almost eight years and now I am taking a break in order to have a hormone test done. But, since about two months I have been having these very unpleasant shivers that won’t go away. Like having the fever but none. I feel extremely hot but when a raft of air hits me, I feel extremely cold. My doctor ran blood and urine tests and everything seemed fine except for Iron which was low. Could all this be a sign of premature menopause? (my mother had hers when she was 50). I had been eating a lot of dairy products in the past months and my diet is mostly vegetarian, so could this mean anything? I have other tests in schedule but unfortunately in the country I live I have to wait for long months until the tests are done. Any hints or suggestions will be highly appreciated. Thank you for your time and for all the info you put out there.

    • It could be the low iron. As a vegetarian, you are likely to also be deficient in zinc and vitamin B12.
      If you’re experiencing hot flashes, it could be withdrawal from hormonal birth control. Have you started back with your real periods yet?
      Finally, it’s worth checking your thyroid, if that has not already been done.

      • Thank you for your reply. I have yet to have my first period after Nuvaring removal. This week will be four weeks since I took it out. The flashes started about two months before I reomved the ring, and I have read they come in waves so to speak but in my case I wake up and go to sleep hot and in cold sweat (if that makes sense). Thyroid test was done also two or three months ago and came out uneventful, but I would like to ask for a re-test from an specialist. My hormone test should be scheduled for the next days so I will ask also for zinc and vitamins levels. What really worries me is the hair, I have really lost a conspicuous amount of hair in such a short time and I am afraid to think it will not grow back.

        Thanks again for everything you write here and all the work you do.

  24. Hi, Lara! I’m finding your blog very helpful. I have a bit of background to offer and a question to ask. I began having anovulatory cycles about a year ago and my health went into a tail spin (I am now 39). I had about two dozen of the typical horrid symptoms of estrogen dominance, except that my periods went from being normal to being very, very light, just spotting most months and I lost about 50 pounds in 12 months from sleep deprivation and my digestive system being impacted by stress on my nervous system. I have been supplementing with magnesium, Vitamin D (my level was tested as low), and micronized progesterone along with Calcium D Glucarate and a couple of other supplements to reduce inflammation. Almost all of my symptoms are well in hand now after 6 months, except I now have intermenstrual spotting off and on from ovulation all the way to my period (which lasts 2-3 days longer than it used to and is still extremely light). I suspect that I might have the form of estrogen dominance in which estrogen is not actually that high but progesterone is still so much lower that the ratio is out of whack. That would make sense with the intermittent estrogen breakthrough bleeding but never any flooding or heavy bleeding that so many women describe. The lining is apparently not getting hugely thick but is not stabilizing and breaking down a little at a time.

    I have ordered a P/E ratio saliva test to take at home (from ZRT Labs). I am wondering if it will give me any useful info with my cycle this erratic. Do you suggest a particular day in my cycle to take the test if I am in perimenopause, or should I just pick a day and see what the test results show? Even if I’m not actually ovulating, my body is obviously trying to crank out the estrogen in the second half of my cycle since it’s typically 14-16 days into my cycle when the spotting starts.

  25. Dr Lara Briden, what are your thoughts on estriol cream used on skin (not vaginally) for alleviation of estrogen deficiency symptoms for women who might be scared of estradiol? Thanks Sheila

  26. I am a 70 year old male. Excellent health. Retired high school P.E. teacher. I have a few prostrate cancer cells “somewhere” in my body after a radical prostatectomy and 8 weeks of radiation therapy over the past 5 years…evidenced by a very slow increase in PSA level. If the PSA continues to increase…a later step is HRT. But, I am leaning toward an orchiectomy instead. I would also (based on my research) like to add a small amount of estradiol (patches) to take the place of testosterone as a human hormone in my body. I am interested on YOUR feelings about adding estradiol patches. I am not concerned about any secondary female characteristics which might develop. I am more worried about the possiblity of fatigue and lack of energy–I am a very active guy…workout at least 3 to 4 times a week at the gym and play some golf (walking the course) too. It seems that “they” demonize estradiol and much that is feminine. I would like read some of your thoughts (not binding in any way) about what you theorize might be the effect of estradiol on me (good/bad)? Thank you for reading my message.

  27. Hi Lara,
    Thank you for this blog and for your book. I’ve found both so informative.
    I was wondering if you have any more information about vegetarian diet as a cause of estrogen deficiency and whether vegetarian diet could contribute to long term amenorrhea.
    I have had amenorrhea for many years and have never been able to properly identify the reason I’m not ovulating. I’m 31 now and my periods stopped when I was 24. The doctor found everything was normal except for low estrogen and recommended the pill for my bone density. I came off the pill for 6 months at age 28 and still failed to menstruate and i experienced post pill hair loss. I also failed a progesterone test and went back on the pill. I came off it again 2.5 months ago and am experiencing hair loss again.
    I don’t think I have typical PCOS. My ovaries look normal on ultrasound and I am not insulin resistant. All my androgen levels are low to normal on a blood test, but I do have the post pill hair loss and I think I have mild hirsutism so it’s possible I do have some form of PCOS.
    I’ve wondered about my thyroid as my sister has hashimoto’s and we have lots of autoimmune conditions in the family, but my TSH is consistently normal at around 1.9.
    I’ve also thought about hypothalamic amenorrhea. My BMI is normal at 19 and I eat a lot of starch and fat now. At the time I lost my periods I was eating a relatively low calorie diet and exercising a lot, but I’ve been gentler on my body for years now, including at the last time I came off the pill. Back then I even tried putting on weight and increased my BMI to 20 but I still didn’t get a period.
    So now after ruling out everything else I’m thinking about my diet. I’ve been a vegetarian for 15 years and in the early years I was pretty unhealthy and just ate a lot of pasta but had regular periods. my period problems actually started around the time when I adopted a healthier vegetarian diet with a lot more beans and pulses and nuts and veggies and less processed food.
    My iron and B12 are normal. My doctor doesn’t test zinc but I’ve started supplementing it two months ago after reading your book.
    I’m considering trying vitex once I’ve been off the pill 3 months as my LH is low but my prolactin is normal so it may not work. I also have a very thin womb lining on ultrasound, which apparently suggests estrogen deficiency.
    I’m wondering if there are any dietary changes or supplements you recommend to help me ovulate as a vegetarian and to boost estrogen. I’m not prepared to eat meat for ethical reasons, but I do eat eggs and dairy. I have considered stopping dairy after reading your book, but that would bring my saturated fat intake right down which might not be great for estrogen either. I eat minimal refined sugar and vegetable oils but I do eat a fair bit of wheat.
    I really don’t want to have to go back on the pill this time and I want to start ovulating again but I’m so confused about what’s going on.
    Kendra

    • I’m thinking about writing a blog post: How a vegetarian diet can cause amenorrhea. Not in everyone, of course, but in some women. It’s mainly to do with a lack of key nutrients such as protein, zinc, vitamin B12, iodine, choline, fat, iron, and taurine. But also because a vegetarian diet is high in phytoestrogens (legumes), which can suppress ovarian function.

      • Thanks for your reply. A blog post would be really helpful, especially if you have advice about how to restore ovulation on a vegetarian diet.
        I had thought soy was the main phytoestrogen, but I looked it up just now and it turns out everything I eat on a regular basis is phytoestrogenic. Beans, lentils, tofu, oats, rice, flax, quinoa etc. are the staples of my diet. It would be good if your post could address options for obtaining protein without getting too many phytoestrogens as a vegetarian. Are some phytoestrogens stronger than others and better to avoid?
        I plan to give myself a good three months on zinc and off the pill, but if that doesn’t work, i’ll have to start looking at possible dietary changes. Last time I had a period was after taking iron supplements for a little while but I stopped because the doctor said my iron was fine and iron deficiency couldn’t affect menstruation, but it could be that I have some underlying nutrient deficiency issue. On the other hand my issues could equally be due to PCOS or Hypothalamic Amenhorrhea, which is why its so difficult to know which approach to take.

        • Oh dear. If we aren’t supposed to eat any of that above Beans, lentils, tofu, oats, rice, flax, quinoa etc and also not supposed to eat dairy what on earth can we eat? just meat, fruit and veg?

  28. Hi Laura,

    I am 32 yrs old. I stopped BC about 10 months ago and haven’t had my period since. Even on BC it seemed like the last month of taking it I had very little bleeding. My recent hormone test came back all normal except really low estrogen (reading of 12). Not sure if the lack of periods is caused by low estrogen or vice versa.

    Per your book’s recommendation, I have been taking vitex (going on second month now) and just started shatavari to boost estrogen. I know you say that phytoestrogens may not be appropriate as in some case they actually lower your natural estrogen. Should I be continuing to take it in my case?

    Also, since my prolactin levels (6.8) seems to be normal, should I continue taking vitex? From what I understand it decreases prolactin levels.

    Thank you for all your help.

    Best wishes

      • Thank you for your response. I am eating plenty and have been avoiding gluten and sugar per your book’s recommendation. Am I OK to continue with Vitex even though prolactin levels seem to be fine?

  29. Hi Dr. Briden! I know you recommend when during your cycle to test hormones, but I can’t recall if your book suggests how to test them (blood, saliva, etc.) and if you have a recommendation for a specific test. I also wonder if we really need to test at all? I’m 47 and was recently diagnosed with endo.

    My practitioner recommended the Dutch Test Complete (https://dutchtest.com/product/dutch-complete-2/) Dutch test is supposed to be comprehensive hormone test for things like free cortisol, melatonin, estrogen/progesterone/androgen, some methylation, metabolites, etc. (video here a/b what it includes: https://dutchtest.com/video/introduction/ ). Cost is $400 and insurance won’t reimburse so wanted to check to see what you thought and any alternatives you may suggest. THANK YOU for any insight/guidance/help you could provide.

    This is what Dutch Test Complete says it includes:
    – Analysis of 35 different hormones: estrogen, progesterone, testosterone, DHEA, and cortisol along with their metabolites
    – Daily free cortisol patterns to provide insight into ‘adrenal fatigue’ or symptoms of chronic stress
    – Graphical representation of results and embedded video tutorials to assist in the hormone assessment to share with your medical provider
    – New! Oxidative Stress Marker – 8-Hydroxy-2-deoxyguanosine (8-OHdG)

    • As I explain in my endometriosis post, endometriosis is not a hormonal condition. It’s an inflammatory condition that’s affected by hormones. Therefore, I usually do not do hormonal testing for endometriosis.

      I do hormonal testing for other conditions, and I mainly use blood tests. Day 2 for FSH and LH and AMH. Mid-luteal for estradiol and progesterone. Any day for prolactin, thyroid, insulin, androgens, etc.

      • THANK YOU! One other question. I’m considering a hysterectomy to reduce the pain of endo. I’m already off gluten and dairy, and have started taking all the things you recommend in The Period Repair Manual (which is a godsend and I’ve recommended it to dozens of women). If I do get a hysterectomy (I’m 47) I’d like to go on bioidentical hormones for several years b/c I have a family history of heart disease, alzheimers, etc. So my question is, is there any additional testing you’d recommend before the hysterectomy to help me better establish a baseline so that when I’m taking bioidentical hormones, it will be easier to titrate the doses and figure out the right doses? THANK YOU AGAIN!!!

        • So you plan to have total hysterectomy? (ovaries removed)
          That does not necessarily cure endometriosis, but it does cut off the supply of estrogen that aggravates endometriosis. But then, if you take estrogen, you could be back in the same boat.

          • Thank you Dr. Briden. I can’t tell you how grateful I am for your replies!!!

            I haven’t decided on anything yet. I am still trying to figure it all out. My plan is to get MRI to try to figure out if I have adenomyosis. I’m also trying every single natural remedy you suggest in your book to try to reduce pain/fatigue/inflammation.

            Do you have general guidelines for patients about how to decide on getting a hysterectomy or not? (partial or total). I would think that if I can reduce pain/fatigue/inflammation via natural remedies/diet, then I wouldn’t need hysterectomy. But I’d love any guidelines/insight/suggestions have on how to decide on getting one (and then if I need one – partial or total).

            Thank you again!

  30. I experience pms headaches, breast tenderness, vaginal dryness, dry eyes, cold feet, bladder infection, bloating before period, feeling thirsty often, joint and backpain. But also acne and blackheads. Is this typical deficient or excessive estrogen signs? I’ve tried treating with both methods according to your book, but I can’t seem to get it right. It is so frustrating to not get it right and when doctors can’t figure out what the problem is…

  31. Hello Lara:) Do you know of any DIM supplement brands without the indole 3 carbinol? I would value your expert opinion:) thanks in advance!

  32. I’m at an end point, Lara. I have low estrogen but I have acne. DIM helps my acne, but it gives me estrogen deficiency symptoms (hot flashes, vaginal dryness, dry skin …). When I go at a low dose my acne flares up, and I get a burning pain in my bladder that’s horrible. What can I use instead of dim? Or is there some supplements I can combine DIM with that Can help? I tak e low dose (100mg) and without the I3C.

    • Interesting. Thanks for sharing your story. I have been trying to determine if many women experience estrogen-deficiency from DIM. I haven’t seen it with my own patients. Do you ovulate every month? Do you see at least two days of menstrual flow?

      • My first day of period I bleed a lot, and can see small blood cloths in my period. Day 2 is medium, and day 3 is very light. When on estroblock pro I bled very light. But after shifting brand and lowering the dose my bleeding is like I described it and I bleed more, but my acne is back. I ovulate also. I’ve been trying to figure this out for months, but can’t seem to figure it quite out. It is hard to choose between acne and having side effects of low estrogen…

  33. Is it possible to have estrogen excess and deficiency at the same time? I have very tender breasts before my period, some acne and headaches. But I also have dry skin, dry eyes and I’ve had problems with my bladder (freequent urinating) for a long time. All of these symptoms match both. I’ve read your book many times, but never seem to end up at what I have. Hope to hear from you.

        • Yes, it’s definitely possible to have estrogen excess and deficiency at the same time (that’s why I called these two posts “The Ups and Downs of Estrogen”). It’s also to do with sensitivity of the estrogen receptor.

          For younger women (like yourself), I think about “total estrogen” for the cycle. Is it adequate? For example, do you ovulate every month? Also, do you have at least two days of flow.?

          • I bleed medium 2 days, and light the last day. Then spot a few days after that (brownish color). I think i ovulate every month. But I’ve set to take my temp this month when i’m ovulating. If I ovulate every month, will these symptoms then pass by itself?

  34. Hi Lara,

    Is tribulus and shatavari ok for a young woman? Or does it have the phytoestrogen effect of lowering oestrogen in a cycling woman? I’m 28 and was either breastfeeding or pregnant for 6 years. I’ve now weaned my 3rd child and not going to have any more, but I have been suffering what I think are symptoms of lowered oestrogen.

  35. What could be causing my freequently urinating (at night), dry eyes (especially at night/morning), acne, (dry mouth), and pms breast pain? My doctor says all my bloodtest are fine. I’ve had this for years, and it’s frustrating. I also never have a full night sleep. Always waking up several times.

  36. Hi Lara

    I am a 46 year old Sydneysider currently living in Singapore, I haven’t lived in Sydney for 20 years, spending 1996 to 2011 in Singapore and Thailand and the past 5 years in the U.K.
    We moved back to Singapore in August and all was fine. In late September I started experiencing skin sensitivity, reacting to products (ironically a “calming” range from a natural brand called Pai in the U.K. which I had used for 5 years). Concerned I went to a dermatologist who diagnosed rosacea. I was surprised …yes I am of Celtic origin, fair and 1970s 1980s Sydney sun abuse! But I have never had a facial flush in my life, no allergies. So I changed to a new skin care and started using natural oils like Grape Seed. About two weeks ago (when my last period was due) I broke out in a rash on my back and buttocks, I suspected soap powder or something else and headed back to the dermatologist who told me I had eczema and gave me a steroid cream. Again surprised that at 46 I would suddenly have rosacea and now eczema I used the creams an hoped for the best. The itching had been unbearable for a week and antihistamines were having no effect, I used the steroid cream for 48 hours and stopped, the itching was worse, the rash was now bruised looking.

    In the last 3-4 days I have started experiencing flushes……. they tend to come every afternoon and evening. They start with a hot feeling then my cheeks tingle, my forehead, nose, cheeks and chin flame red and I feel lightheaded. When it’s a bad flush I also get a numbness in my hands, sort of a tingling., pins and needles sensation. A bad flush takes about 20 minutes to subside, minor ones are less. In between I can be pale. I have no blemishes or red bumps that are often associated with rosacea. I have also put myself on a fruit and vegetable diet for the last 10 days while I await food allergy results.

    So ……my period has still not come. I have definitely had some irregularity and period issues in the last 2-3 years. These were often so extreme that I went in for a biopsy to check nothing sinister was going on but along was ok.

    Practitioners seem reluctant to do hormone testing and I don’t know if maybe it is just eczema and rosacea that has suddenly arisen. I should say that even in the las five years we spent term time in the U.K. And holidays in Asia so this is not a dramatic climate change for me.

    My gut says hormones, not rosacea. I have read, but can’t remember the name, of a medical term for itching that isn’t helped by antihistamines and is associated with perimenopause. I also know that no periods means no ovulation which means estrogen deficiency and from what I’ve read this can result in the flushing and rashes I am experiencing.

    I’d love some advice.
    Thank you
    Leanne

  37. Dear Lara, I am a 54 year old woman suffering from horrible insomnia. I went to my OBGYN and she put me on the low dose patch of HRT progesterone/estridiol… it did not help with my sleep. I recently went to an endocrinologist and had my estrogen levels tested . I was not on any HRT at the time. Levels read Esterone 33pg/ml, Estridiol 34pg/ml, Estriol <0.10 I was told to me was that my estrogen was low. I am so confused because I thought insomnia was due to high estrogen. I also am having difficulty gaining weight and I get headaches everyday. I do supplement with magnesium bisglycinate 200mg during the day for headaches and when I wake up in the middle of the night.

    I take about 600mg per 24 hours. Also I supplement with 1/2 a 1mg tablet an hour before bed with melatonin. I have tried 3 mg but it doesn't work as well as the lower dose. I also practice all the proper sleep hygiene so I tend to believe this is ALL hormonal! I take a b-stress complex as well as 11mg of zinc for tinnitus that suddenly cam on the this hormone changes. My diet is free of alcohol & sugar, I meditate,walk and do yoga 3x a week to help alleviate this trying time of feeling awful. HRT doesn't agree with my very sensitive body so **I have recently started using a natural progesterone cream w/estradiol (each full pump provides 20mg of progesterone and 0.75mg of estradiol.

    Incidentally I had a saliva test when all this started back in February the results of that were Estridiol 13, Estriol 6(depressed), Progesterone 44, Testosterone was normal 29, and DHEA 3. I tried just using the natural progesterone cream 10mg am/pm I felt calmer during the day but it wasn't doing much for sleep.

    Can you make any suggestions given my blood test results? Do I have HIGH or LOW estrogen? And is using the progesta care plus estriol a good idea? I am questioning the estriol part of the cream………..because I am not sure I am doing the right thing and feel like I am in this alone. The estrogen information is so dizzying and confusing to me.

    Sincerely.
    Patty

    • From Patty, additional information from October 4th post….. I thought it might be helpful to include my
      T3, 3.0
      T4, 1.3
      TSH 1.29

      Thank you!

      • Hi Patty, Just started with the exact same symptoms as you. In fact, I felt like I could have written your post it was so similar – even the ringing in the ears. I have a low Vitamin D level – I thought that was causing my symptoms. I had it in the back of mind that it was hormonal…Did you find a solution? How are you feeling?

  38. Hi Lara,

    It wouldn’t let me reply to your latest comment, hence why this shows up as a new comment. To answer your question, I have had my thyroid checked every 6-12 months since my hair loss and other symptoms started 2.5 years ago. In the first couple of testing rounds, they just tested my TSH levels, and then progressed to T4, free levels – all normal.

    My latest round of tests was on 7/16 and included: CMP14+5AC, CBC With Di⌀켅erential/Platelet, Testosterone (serum), DHEA-Sulfate, TSH, Vitamin D, Testosterone (free, direct), thyroid antibodies, ferritin, FSH, total estrogens, and Sex Horm Binding Glob, Serum – all came back normal (though total estrogen was on the very low end of normal). When my hair loss first started, I had very low vitamin D (13) and borderline low ferritin (52), but have been able to bring those up in the last year with supplements (vitamin D – 51, ferritin – 68). I’ve also had an ANA panel and AMH test.

    My questions are:
    1. What else is there to test?
    2. In general, how do your proceed when symptoms are present, but tests are normal (I say “in general” b/c I know you can’t speculate on my particular case)?
    3. Do you offer virtual consults?

  39. What are your thoughts on a phytoestrogen cream to treat estrogen levels that are on the very low end of normal (combined with symptoms of estrogen deficiency)?

      • Hi Lara, I’m 35. My mom completed menopause by age 40, but all of the tests they’ve done to rule out early menopause (FSH, AMH) have come back normal. I discontinued the pill (orthi-tri-cycle lo) 14 months ago and have had bleeds about every 26 days since, though they are accompanied by lots of spotting before and after (along with hot flashes, anxiety, hair loss, low libido, dry scalp, etc). Why do you say definitely not?

        Thank you again for your blog and book, they have been so very helpful as I navigate all these hormonal issues after baby #3.

        • Maybe “definitely not” is phrased too strongly, but the reason is that phytoestrogens generally have an anti-estrogen effect in cycling women. What you really want to do is promote regular healthy ovulation to make your own estradiol and progesterone. Do you think you’re ovulating every cycle? Is your flow heavy or light?

          • Not 100% sure if I’m ovulating or not. My periods were like clock-work and very heavy pre-kids and in-between pregnancies, so compared to that history, they’re currently on the lighter side. I typically spot for a day or 2, have moderate-light bleeding for about 2-3 days, then spot for 4-5 days. Sometimes I’ll completely stop bleeding for a day, then pick up the next day. Weird.

            Anyways, it would be weird if I’ve have annovulatory bleeds for 14 months on average every 24 days, right? I’m guessing I ovulate sporadically?

          • Please talk to your doctor about a thyroid test. Thyroid problems often show up as spotting, hot flashes, anxiety, hair loss, low libido. I discuss a spotting-thyroid patient story in my book.

          • I should also ask – is it normal to stop bleeding for a day in the middle of your period, and then pick up the next day? This has been a new off and on again symptom for me since discontinuing birth controf about 14 months ago…

  40. I am a 69 year old woman with chronic insomnia. This issue began after menopause which occurred almost 20 years ago. I have never been on estrogen therapy. I am now only getting 3 to 4 hours of sleep a night (no naps during the day) with the help of 10 mg of zolpidem nightly. Would estrogen help me at this point or is it too late? Please help…Diane

  41. I am finding your website to be so informative! I may need a trip to Australia! I am almost 47 and a few months ago started skipping periods – made it through all the labwork on the right days and found out my progesterone is almost nothing, my estrogen is below the scale, they don’t even go into further details, my FSH has been rising – 3 tests in 5 months from 12, to 20 to 26. DHEA and LH are all good.

    I do have Hashimotos and my Ft3 and ft4 are typically on the low side (take naturethyroid).
    Morning cortisol is low, but I take supplements to boost and also try for myer’s cocktails a couple of times a month for added support.

    My worst symptoms are bloating, night sweats, sleep issues, breast soreness, feeling like my period was coming and scale went up 15 lbs between March and July! I have always exercised, eaten well and never had a weight issue! I can’t lose a pound to save my soul. My NMD has me trying 25mg oral estradiol the first part of cycle (she suggested more, I was a bit worried) and 100 mg oral progesterone the last half of the cycle. I am getting my energy back but nothing else is changing. I am not sure what to do but I can’t stand how long all this takes – and feel myself starting to panic about how I feel and look – ugh! Any thoughts?

    • Menopausal weight gain is from the insulin resistance that occurs when when estrogen drops–Making you less tolerant of sugar (concentrated fructose). Have you tried quitting all sugar.
      The estradiol should help insulin and other symptoms within a couple of weeks, but it usually works better as a transdermal (patch or gel).

  42. I located this page when trying to follow up on an interview you gave, in which you were asked about ashwaganda (and rhodiola) but then the discussion went in a different direction and you didn’t get back to it. I am long postmenopausal (going to be 70) and have insulin resistance and high androgens. Is ashwganda OK for me to take?

    As for estrogen – I have been using Bezwecken cubes with estriol. Is that a reasonable approach?

    Thanks!

    • Ashwagandha is a very safe herb, so should be fine in that situation if you’re using it for general energy support. However, it’s not specific treatment for either insulin resistance or high androgens.

      Do you mean these Bezwecken hydration cubes for vaginal atrophy? https://www.amazon.com/Hydration-Cubes-1X-12/dp/B00FYL4HBI
      I hadn’t heard about them before, but they look great. Thanks for bringing them to my attention. Yes, estriol is very gentle and safe. It’s a good choice for relieving dryness.

      • My PCP recommended the Ashwaganda for high androgens, so I’m disappointed that it doesn’t work for that. It’s so hard to figure out what various herbs might do, because so often internet sources say “This works for hormones.” But they don’t say *which* hormones.

        She also said that I might want to try taking Pregnenolone, because my levels of that are about zero. I haven’t tried it yet because I saw very mixed comments. I became concerned that if I took more Pregnenolone it would just be used to make more androgens.

        Yes, those are the right Bezwecken cubes. You have to be careful because they also have ones with DHEA, and I think they have ones with no active ingredients at all. The Estriol ones come in 1x (the ones you found) and 2x. The 2x are cheaper per unit of Estriol, but from what I understand the 1x is all you would absorb anyway. The instructions I followed when starting them was 2 weeks of 1 each night (definitely at night, when lying down, or you will have greasy underwear!) and then less frequently.

        Thanks for your reply. At least I haven’t harmed myself with the Ashwaganda. I am pretty sure that drinking White Peony tea is ok too. (Can’t use licorice because of HBP.)

        Any suggestions would be very welcome. Thanks.

  43. Hei Lara! I’ve read ur book and i’m not shure what approach to take. Because some of my symptoms says both estrogen and progesterone deficiency. My cyclus has gone from 30d to 37d and are now back at 32d. I have a little spotting before period (1-2 days), and have medium pain 1-2 days when my period begins. I have dry eyes, i’m tired often and have night sweats. I also have acne, and got them for 5y ago after stopping bcc. I often get better in my acne when my period begins. Before and after the acne is severe. Could the cause be estrogen deficiency?

      • I have also taken a hormone test. But since my cyclus is so irregular atm it is not easy. I had a refjlar cyclus for about 3-4 months ago but i began vitex (and estroblock) and it ruined my cyclus. I’ve now stopped taking itp. But my blood tests said i was low in estrogen (0,19), testosterone (1,2), progesterone (3).

          • I got my period 21 days after. I took the test 17th of june and got my period july 8. I think I ovulate. I always hurt around my ovulation, and feel something happening. But I have not taken the temperature. But I get a sticky discharge, but I don’t get this discharge every month. I’ve tried to figure out for years what’s wrong with me. Going to all kinds of doctors and Naturopathic doctors, but no one gives me the right treatment. So my acne and symptoms never go away completely. Frustrating.

      • I also don’t eat any gluten, sugar or lactose. I’ve not done that for about 3 months on the sugar part. Gluten and lactose i’ve cut out around 10 months maybe longer. (I answeared ovulate in the comment above)

  44. Dear Lara,

    Thank you for your blog and book! They have helped me a lot over the last year.

    I, as a lot of women here, feel not taken seriously by western medicine. I have not had a period for a year since stopping BCP.

    I am 28

    55 kg – 168 cm – BMI 20 (excersize 3 x a week for 1 hour, lift weights)

    no period for a year

    took the BCP 14 years (microgynon)

    did a progesterone challenge and failed.

    bloodwork done twice:

    FSH 8, TSH, 2,9, Estradiol 98, prolactine 0,31 (second one was similair.)

    Had an echo where they could only find one ovary with 10 or 12 eggs.

    Went to three gynaecologists who all agree that is must be PCOS even though I have none of the other symptoms.They think I had no withdrawal due to low estrogen. They suggest going on the bcp for a month to test. They also say I will never get a period on my own and that I should come back when I wish to conceive to get clomid which is my only option to get pregnant.

    I tried Vitex for three months without succes. I am now taking White Peony and Liquorice as suggested in your book. I have had a lot of EGCM all year.

    What can I do next?

    Thank you for helping so many girls and women with our fertility and understanding our bodies.

    Best wishes, Maria Smit

  45. I feel so relieved I found your page this evening! I’ve already read through many of your articles and Its so interessting.

    First, where can i buy your book from a trusted source that ship to Sweden?

    And second, I understand if you dont have time to reply to every comment you get, but I’ll give it a try as I have been extremely frightened about my condition and in Sweden they dont know much about hormonal imbalances, so there’s not much help.
    I am 26 years old. I had amennorea for almost 2 years 2009- august 2011 due to extremely low body weight (eating disorder). My period returned in august 2011 at a BMI of 16.2 the first and second bleeding was very light and about three weeks apart but after my third bleeding that ocurred in october 2011 my cycles got up to a normal 28-30 days. I acually got pregnant (nog supposed to happen!) in march 2012, 22 years old and a BMI of 16.8. I kept my baby and gave birth to a healthy girl in december 2012.
    Pregnancy was fine, i experienced extreme insomnia during somr phases and i got pregnancy diabetes (i dont know how you call it). The doctors had no idea why I developed diabetes as noone in my family have it. No one in my family is over weight or have any autoimmune disorders. I breastfed without any formula or any orher foods for 6 months, and then continued to breastfeed partly until april 2014. My period after pregnancy returned in july 2013 and had a cycle of three weeks the first month but got up to a full 30 days and regular directly after that first cycle. I never charted my BBT at that time but for what I know now I think I did ovulate every month. I did go through depression after my first pregnancy, not extreme but I was feeling very low and for what I know now I think I suffered from PMS or PMDD the week before menstruation. I never lookez into where I was in my cycle when I got that extreme depressive feeling, but I know it shifted over night. In march 2014 I started a very low carbohydrate diet, and succesfully got pregnant in september 2014. I was free from eating disorders and had a normal BMI as I just couldnt lose weight after pregnancy, it just didnt happen while breastfeeding. My last pregnancy went fine as well, although i suffered from EXTrEME insomnia before placebta took over the hormone making process, and i developed even worde gestagional diabetes. I managed to give birth to a beautiful and healthy (normal weight) baby girl in may 2015. Although her bloodsugar was lo at 2.0 I think. When menses ocurred in october 2015 all hell break loose and I have lives in complete fear of never being able to be normal again. My symptoms where all over the place but the most dramatic of them all was SEVERE insomnia. I just did not know HOW To Fall asleep! It didnt happen til 5 am in the morning. I had really bad headache right from the start post partum and experience still, avually I think i has this symptom during myfirst pregnancy as well. I checked BBT right from the start and found out that I ovulated every cycle but had a luteal phase of only 3 days, it gradually went up to 5,7,9 and 10 days and now I have had a luteal phase defect on 10 days for half a year and its not increasing any further. I use progesterone cream during LP, if i dont I get extremely moody, screaming at my kids, looks like I am pregnant and just many many synptoms of low progesterone.

    But as for my problem with estrogen : symptoms dont diassapear when bleeding occurs. During the first days of my cycles I feel extremely low, I cant take care of my kids, I just want to lay in bed alone. I ovulate on day 19-20 at the EARLIEST and have a luteal phase of 10 days. I cant sleep, i feel like Im really low in seratonin and I guess that affects my melatonin as well – I just cant sleep some nights! What I find odd is that its not every night, its almost like my estradiol is really up and down, or changing a lot the day til the next..? I really need to do something about this depression that has started since my periods returned.. Do you think this is due to low estrogen and what should I do?

    I had adrenal fatigue as well and really hit the wall during january 2016. i found a homeopat and applied kinesiologist that helped me get my adrenals back in shape with mineral salts and now I can get up in the mornings, but he cant help me with my hormone problem as he has never had anyone as young as I am while experiencing problems of a perimenopausal lady. I have both estradiol deficiency and estrogen dominance, or at least thats what i think.

    I currently take 300 mg progesterone(cream) during luteal phase (it does not lengthen my LP), i take L-glutamine powder 6 grams a day, zink 30 mg a day and 5000 IE of vit D. I eat healthy, no e-numbers, organic meats and vegetables, no wheat or milk, except for some butter. I exercise almost every day (1,5 quick walk or 40 minutes on crosstrainer). I drink a lot of water, i dont use chemicals like lotions, schampoos, cosmetics or anything! im really “back to basics and cant understand why my body isnt working! I am always tired (although MUCH better since my adrenals started producing adrenalin and cortisol again), the only day I feel really good is on ovulation day or few days before. Post-ovulation days have been better now due to the progesterone but this cycle I found out that it messed my cycle up as i got a breakthrough bleeding on day 10 wich lasted 5 days as a normal menstrual bleeding does for me. I never ovulated that month either and none of these have never ever happend to me before. I always ovulate and i never have a breakthrough bleeding, I never spot eiither. I got ovulation mucus and my cervix was soft during day 20 but my temperature never rise and now Im dry again so I know progesterone caused me not to ovulate – should i stop using it during LP? I just CANT function during LP if i dont supplement.. But I need to ovulate as well as I have my estradiol problem.. This is just a complete mess!

    I took a saliva test in february this year. My LP was up to 10 days by then. And thats were Im currently at.
    Progesterone: 107.33 pg/ml
    Estradiol: 1.14 pg/ml
    Ratio progesterone to estradiol: 94.40

    Reference range for estradiol was: 1.0 -10.8 pre menopausal ( wich makes me very low as Im only 26?)
    And progesterone : 127-446.

    This was taken 8-9 days after ovulation.

    Im sorry if this is really confusing. But to summarise: i had insuline resistance during pregnancy and guess Im not completely well now, even though i dont have symptoms. I had severe insomnia during the forst 3 months while pregnant, also the last month in pregnancy. I experienced severe insomnia and headache after periods returned after pregnancy, still having insomnia during folliculat phase but it can somewhat change from a day to the next. My mood really chanches during follicle phase. I feel depression ease when mucus becomes watery. I lost almost 40 % of my hair after pregnancy. I just cant lose weight and steadily gain on a healthy diet (“low carb ” as in low but not extremely low. I eat some oats, ray, quinoa, sometimes potatioes etc but smaller amounts). The weight is really a problem for me as i feel extremely out of control and currently I have a BMI 21 wich is good but it scares me that Im continuing to gain. I dont gain much during pregnancy, its after the pregnancy- do you have thoughts on why? I also retain a log of water, not only during LP, acually i retain less during LP as progesterone makes it go away a bit- but it comes right back on during phollicle phase..

    Wow. This ens up long… Anyway, so happy to have found your site! You can help so many women with your knowledge. Thank you so much.
    Nina

    • Oh and also, since the birth of my second i have experienced extremely night sweats. Although its much better now. Hot flashes as well, i still have them. And melasma above my mouth/under nose. Not extreme, but its defenietly happened something there .

      Thank you Dr.

  46. I am 23 and I think I have low estrogen in my body. I might have pcos, but I am really fat. But this month, I had the worst symptoms of low estrogen. Face lines, low drive, mood swings, dry skin, dry eyes, the whole deal!!! What do I do?

      • Dear Dr, I am SO sorry, I missed out *not. I am not really fat and I do not have an insulin problem at all. What do you think is the problem then?

        • It is possible to be thin and have insulin resistance. Hopefully, your doctor will test that for you. Beyond that, there are different treatments for non-insulin resistance PCOS. Please see 4 Types of PCOS.

  47. Hi, Lara,

    I hope you read my question, though it’s coming almost a year after you wrote this post.

    First of all, thank you for your wonderful blog! I am so happy there are health professionals like you who take female hormones seriously and try to find the actual cause and not just prescribe synthetic hormones.

    My question is this: why do you think some women have a hypoestrogenic period right after their menstrual bleeding ends and before their estrogen starts to rise in preparation for ovulation? I know this is called an inactive phase or a lag phase. I read about this here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3655429/ In my case it takes the form of spotting before I start to see cervical mucus. Then I ovulate (I chart my BBTs), but my ovulation normally occurs between CD18 and CD24, sometimes even around CD30 due to this hypoestrogenic period in the beginning, after my menstrual bleeding stops. I think my luteal phase is OK.

    I was diagnosed with PCOS 10 years ago, but since then I have changed my diet to primal/lower carb and lost a lot of weight (I am normal-weight now – BMI 21.4). My period used to be very irregular (long follicular phases, though I ovulated every time), but now it is more or less regular, only with the above peculiarity.

    In that publication above they mention perimenopause, but my follicular phase has been like that for ages. I even think that hypoestrogenic period in the beginning was the reason I had very long follicular phases when I was diagnosed with PCOS. I am not sure I had “true” PCOS, though I was probably insulin-resistant.

    I am also hypothyroid (not Hashimoto’s) and have started taking iodine to see what results I can get from it.

    BTW, I am 39 now.

    Have you come upon cases like this in your practice? I do not fit the description for “relative estrogen deficiency”, but I do think this is my problem.

    Thanks in advance!

    • Interesting paper. Thanks for sharing!
      My understanding of the paper and the term hypoestrogenic inactive phase (IP) is that it occurs before follicles are recruited–ie. early in the follicular phase. As they explain, it can occur for lots of different reasons. In younger women, it could definitely be part of PCOS picture, but then in perimenopausal women, it is because follicular activity is declining (complicated by rising FSH), which is why some perimenopausal women have actually shorter follicular phases.
      But it sounds like yours occurs closer of ovulation, after there has already been some follicle recruitment. On what day do you see mucus?

      • Thank you for replying, Lara. I see mucus about CD10-CD12 or later. I normally ovulate around CD20 – CD22. I have always felt there was sort of a slowing down of things, before the estrogen really kicked in. So when I read that paper and saw the word “inactive”, it clicked – that was exactly how I had experienced it. But in my case this has been going on for some 10-12 years (the spotting, I mean). Even when I started losing weight with the change in my diet and my cycles shortened (i.e. became more normal in length), the spotting remained. I must say I haven’t tested my hormones for years, I am simply so disappointed by doctors and really would like to help my body in the most natural way possible – by giving it what it needs and eliminating whatever obstacles there are to proper function. Things have definitely improved greatly, since I changed my diet, so I am grateful for that. But I guess this “inactive phase” must be something natural for me. I know I ovulate in every cycle, because I see more and more mucus, then suddenly I experience some tension (during ovulation) and then the temperature rises, as it should.

  48. Hi Lara. Do you think it’s a good idea to use bio identical estradiol and progesterone to support a very rough withdrawal from the contraceptive pill? I tried 2 years ago and had cystic acne – when I had perfect skin my whole life – and periods 3 weeks out of 4. I went back on the pill out of desperation after a year. I am 41, I have 2 kids, and had no such issues coming off the pill to conceive them! Thanks for any help, Suzie.

    • Post-pill acne is extremely common (it’s withdrawal from the synthetic estrogen). However, I don’t think an estrogen supplement is the solution. I rarely recommend estrogen supplements for premenopausal women). Usually, I commence natural acne treatment before stopping the Pill (see Insight Into Acne), and then try to get natural periods going as quickly as possible (because ovulation is how you make estradiol). However, natural progesterone can be helpful.

      • Thank you! I will definitely follow your acne advice. But I have almost no DHEA, and supplementing it above 25 mg gave me acne too, so my DHEA and testosterone were still nil when last measured before going back on the pill. LH and other hormones were fine. And I had estrogen somehow. Can I ovulate without DHEA and T, if i take progesterone? Or am I in too rough shape? Unsurprisingly, I’ve been diagnosed with Chronic Fatigue :/ Thank you for your help.

        • Was your DHEA tested while you were on the Pill? Because the Pill strongly suppresses DHEA, and you may not need a DHEA supplement once you come off the Pill. Also, consider that a DHEA at that dose can cause acne.

          The way you will make estrogen is by ovulating. I discuss the importance of this in my book. Progesterone does not promote ovulation. In fact at too high a dose, it can have the opposite affect. That’s why I generally recommend it but used only during the luteal phase (post ovulation). There are exceptions to that, as in women who have trouble reestablishing regular ovulation.

          • I wish I had never gone on the Pill. My DHEA was tested a couple of months AFTER I came off the pill – it was non-existent then, and still low even with supplementing at 50mg for 3 months! Very odd. Maybe pumping me full of DHEA isn’t the way to go – I think I may be full of auto-immunity, and reacting to this non-bio identical hormone, if it is indeed that. I have Hashimoto’s, so not unlikely, I guess. So I’m going to go gluten and dairy free as part of my pre-Pill withdrawal prep. (I’m reading your book now). And try to find a Naturapath here in Israel who has even half your knowledge! Thank you for opening my eyes, Lara. <3

  49. hello. i have very low oestrogen throughout my cycle but it does go up just not in range so i believe i ovulate as i have a period. can i do anything to raise my oestrogen? i also have lower testosterone (in range though) and low progesterone (some days in cycle) thanks

    • Having a period is not a guarantee that you’ve ovulated. You might want to track your temperatures to be sure. If you DO ovulate, then you are making a reasonable amount of estrogen. It will be at its highest on day 10, a few days before ovulation. I do discuss some ways to raise estrogen in Chapter 9 of my book.

  50. Hi Lara, I’m trying to get pregnant at the moment, but have very low estrogen all the way through my cycle, I am also hypothyroid and experiencing chronic insomnia. I am trying to rebalance my hormones naturally, I guess it just takes time (Fertility drugs probably didn’t help). But the insomnia is really getting me down. Anyway this is a great article, I will try the estrogen boosting herbs! I just got rhodiola, did you know anything about this in regards to estrogen? Thank you.

    • Low estrogen throughout your entire cycle suggest that you do not ovulate. (Because a rise in estrogen is part of the process of ovulation.) Do you know if you ovulate? If you don’t ovulate, then your goal is to promote ovulation (not to boost estrogen).

      • Thank you for replying to me Lara! According to my blood tests I’m ovulating, but it seems my hormones are all running very low. Menstruation is also very light. I just read your blog on gentle carbs, and wonder if this might be the missing link for me, I have been trying to increase my carbs, but maybe not enough. Might also help my insomnia I’m hoping! Thank you for sharing your wealth of knowledge:-)

        • If you ovulate, then you know you have a reasonable amount of estrogen in the middle of your cycle.
          Yes, being too low carb could be the underlying reason for thyroid, insomnia, and light periods.

  51. Thank you very much for your reply. It makes sense because I had heavier period 10 years ago, now I am 34. I might not have estrogen deficiency then. I think I will try first only the turmeric since it’s anti- inflammatory as well.
    If you don’t mind I would like to have another question.
    When I stopped the pill ( 8 months ago) I started to take wild yam root, I thought it can boost progesterone and help to restore the hormonal imbalance. It was recommended by a naturopathist. Actually it didn’t help with the hirsutism thus I wanted to try other supplements and I stopped taking it 2 months ago. So far my cycle shortened to 24-25 days with PMS. While I was taking the wild yam (6 months) it was 28 days and the PMS had improved month by month, no spotting, cramp or headache. I had a deeper look in the net and realized that wild yam cannot be converted by the body into steroid hormones, particularly progesterone, so obviously didn’t do anything with my hormones but somehow it improved my period (I might have ovulated as well) and right after I stopped it my period came in 24 days.
    I read that it has anti-inflammatory effect and I am just speculating now but could this be the reason why I had luck with it since I am considering that I have Type 3 Pcos.
    If my issue is the inflammatory is it possible that only this herb alone could help that much with my periods during the 6 months taking? If it so I would definitely try more anti-inflammatory herbs and diet.
    I would really appreciate your opinion because indeed I am just speculating.
    Thank you so much in advance.

  52. Dear Dr. Lara,

    I had a blood test on 3.day and the estrogen was low I know from your book that it’s normal and it’s supposed to be low at that time so I can’t really figure out whether I have defiency. My only symptom is the light period but don’t have vaginal dryness.
    I would like to start to take turmeric and DIM and maybe reishi mushroom since they are androgen blockers because my DHEA’S and androstenedione are elevated and I have hirsutism but don’t have IR so I think Type 3 of PCOS or adrenal androgen excess can be the underlying issue. I would go for both treatments and diet at the same time.
    You mentioned that DIM and turmeric have slightly anti-estrogen effect. Can they cause significantly estrogen reduction in low dose?
    I feel I have not enough estrogen for ovulation, neither progesterone(I just started to track my temperature so don’t know yet) because before taking pill I had heavier period.
    I’ve been taking Maca since I stopped the pill ( 8 months) and somewhere you mentioned that it’s very similar to the DIM. Is it possible that Maca can suppress the estrogen and that’s why there is the light bleeding. I know you don’t describe but you might have some experience of it. Actually Maca improved my hirsutism a tiny bit but now I am thinking to switch.
    Your book and your website are so helpful, I feel lucky to found them. Thank you very much.

    • One thing to consider is that periods can lighten with age. You say your periods are lighter now than they used to be before you took the Pill. How long ago was that?

      As to whether DIM or turmeric can reduce estrogen too much and reduce fertility, it’s possible, but it’s not something I’ve commonly seen amongst my patients.

      • Doesn’t tumeric have plant estrogen in it which increases estrogen, right?

        I’ve stopped using it and taking the capsule while I try and help my liver detoxify more estrogen (I eat lots of cruciferous vegetables – DIM)

        I’ve also stopped drinking fennel and aniseed tea in this process.

        • Curcumin is a very weak phytoestrogens or “plant estrogen”, but phytoestrogens generally have an anti-estrogen effect in menstruating women. Please see my Soy post for an explanation.

  53. Hi Lara! I’m buying your book ASAP. I have a question though, and I would like to hear your opinion. I recently came out of pill (9 months ago), and my periods are super light. 2-3 days + 1 day of spotting, and very irregular. 32 days, 42, 51, 64…. Total craziness. I don’t even remember how my periods were before the pill, but I do know that I had my menarche very late in life (I was 14/15 years old). I also suffer from vaginal dryness (have to use lubricant every time, and often I get a fissure at the perineum), and during the time I was taking the pill (for 8 years), I had to replace estrogen locally 3 times in 2 years. I would insert estrogen capsules inside the vagina. I don’t know if all this is related or not…. My question is if you think I should wait a little more to see if my periods will become more regular, and then maybe my problem with dryness and light period will go away, or if you think it is ok for me to take some supplements like the ones you suggested (Tribulus). What do you think? Also, what is the ideal daily dose for tribulus? Thanks!

      • Thyroid is very important for period health and ovulation. You’ll see in the book, I describe extra parameters for assessing optimal thyroid function. For example, is your TSH between 1-2.5? Do you have thyroid antibodies? These questions are important even if you are already on thyroid hormone replacement.

    • Hi Marina, As you’ll see in my book, the big question is whether you ovulate or not, and if not: What do you need to do to ovulate? As soon as you ovulate, you will start to make more estrogen.

  54. Hi Lara

    My issue is significant hair loss. I am 50 years old and have been in menopause since 47. I am 5 foot 6 and weigh about 122 pounds. I eat a pretty healthy diet, usually exercise regularly, but struggle with sugar cravings.I take Omega 3, black current oil, vitamin C, B complex and D each day. At night I take 2 magnesium citrate and a scoop of RelaxMax by Xymogen for sleep.

    I experienced significant perimenopause symptoms between 45 and 47, with the most debilitating symptom at that time being regular bladder infections and extreme vaginal dryness. I was prescribed Vagifem at 46 and this has done a pretty good job of eliminating the bladder infections, and for the most part vaginal discomfort. I currently also use a dab of an 0.6 mg estriol compounded cream along with the Vagifem and it has really helped.

    A year ago (49) I quit taking 10 mg of Elavil as it was supposed to be helping the migraine headaches, and I felt it wasn’t doing anything. Coincidental or not, at this same time I developed insomnia, cellulite blossomed all over my body and I began experiencing significant thinning at the crown of my head.

    10 months ago I visited a hair loss doctor who diagnosed female pattern hairloss. I began use 5% minoxidil but with minimal visible changes at the 6 month mark, I added the Hairmax laser comb to my regime as per his suggestion. Although I do see some new growth, my hair has been shedding ridiculously for the past 4 months. So much so I have to use a hair powder to hide the baldness on top of my head.

    Shortly after I started using the minoxidal I also started taking 100 mg of Prometrium as I was nervous about using the Vagifem supplement without progesterone, but also as I read it might stimulate hair growth. After 12 weeks I felt the progesterone was causing depression and stopped it. I tried taking it again a month later but again experienced depression and stopped.

    At this point I am so very confused and looking back over the past year question everything – the Elavil, Prometrium, minoxidil, laser comb, my diet – do not tolerate dairy well, and use soy milk in my latte. My gut says it is my probably my hormones, but if I begin HRT, I have read it does not always result in hair growth, and eventually I will have to come off it.

    I would so very much appreciate your insight into my dilemma.

    • There are so many factors in hair loss including thyroid and insulin balance. Have you been assessed for thyroid antibodies?

  55. Dear Lara,

    I woke up this morning to find my period had ended just as a healthy period should. I am 23 and I believe this is the first time that has happened in my entire life. I couldn’t wait to get on your website and thank you SO MUCH for your book “Period Repair Manual”. I read it, did my homework and changed my lifestyle – 4 months later my period is about 40 ml in volume and only 3 days long. THANK YOU. I am profoundly grateful!

    I want to give you an idea of what a transformation my period has undergone from following your advice – 4 months ago I started out with a 155 ml period that was 8 days long. I was iron deficient, a vegan, and was still feeling the terrible effects of coming off the pill and I had seriously scary PMS. Now, besides what I listed above, my mood is incredibly lifted, I no longer have thrombocytopenia, and I didn’t suffer at all from PMS! I didn’t even notice my period coming this last cycle!

    So again I just want to thank you for publishing your book. You have given women like me a valuable resource to improve our lives. I can’t thank you enough for the guidance, healing, and goodness your book has given me, and certainly thousands of other women. I am sure that the healing and goodness you’ve contributed to this world has given you have an Unimaginably Large Ever-growing reservoir of good karma – and I sincerely believe it will come back to you in life.

    Respectfully,
    Lizzy

    • Hi Lizzy,
      Thank you so much for the feedback. I’m happy my book is doing the work it is supposed to do (to help you all).
      If you get a minute, can you please leave your thoughts as an Amazon review? That way, other women might make the decision to read the book too.
      warmly, Lara

  56. Hi Lara, I just listened your guest episode on the primal shift podcast today and am so glad I found out about you.

    I have been seeing a wonderful naturopath to fix my acne and my menstrual absence (I call it “the black cycle”) that I’ve been having since I went off the pill for good last December (nearly 10 months ago now). I’d been off and on the pill since I was 16/17 (I am 21 now) – and originally was recommended by my gyno to go on it when I had ammenorhea when I was 16). I was running a lot and not eating enough and my body weight was just way too low and my diet was way to restricted. That has all been changed for at least 3 years now.

    My BMI has normalized and I’ve gained about 15 extra pounds just in the past few months – I’m guessing from my low estrogen levels (I recently had bloodwork done and estrogen was the only thing wonky and abnormally low). I’m currently about 5’5″ and 127 pounds. My naturopath has tried me on unda numbers, seed cycling, magnesium supplements, castor oil packs, no gluten and dairy, vitamin b complex, probiotics, ovarian meditation, and a handful of other remedies and nothing seems to want to change – except for my pant size that keeps increasing. My acne is subsiding slowly, and I have been working to eliminate stressors. My diet is good, I eat red meat once or twice a week, organic fruits and vegetables, and healthy fats – exercise regularly maybe three hours of cardio a week and just light walking. I’m curious if you have any insight – I’m at the point where I am getting ready to simply construct my own red tent to sit in until I finally start to bleed again.

    • Wow, Grace! I’m no doctor, but you having put on 15 “extra” pounds getting you all the way up to 127, I’d say that you just don’t have enough meat on your bones to sustain a menstrual cycle. Women need fat on their bodies to tell the body that we are capable of carrying a potential baby to a healthy birth. The way I understand it, estrogen is stored in our fat cells. It sounds like you have a very low fat amount on you, maybe that accounts for the low estrogen. At 127, you’ve just barely entered the “average” weight for a woman of 5’5″. Maybe a couple more pounds might help. At 21, you are so young and you have so much life ahead of you. Take good care of your beautiful body. 🙂

    • I like your image of the red tent!

      Interesting, you say you had amenorrhea before you went on the Pill (presumably because of your low body weight). But have you ever had a real period? I assume your doctor has ruled out obvious issues such as thyroid, prolactin, and coeliac disease? (I know you avoid gluten, so that might be hard to test for.)

      Keep in mind that you’ve only been off the Pill for 10 months. It’s really early-days. Post-pill amenorrhea is common and can persist for a year or more. Also, you’ve only just gained some much needed weight in the last 3 months. You may very well reap the benefit of that in the coming months. If you’ve read my book Period Repair Manual, you’ll know that it takes 100 days to bring a happy ovarian follicle all the way to ovulation (and therefore to a period). It’s just barely 100 days since your follicles started to be happier.

      Your diet sounds better than it was, but please do make sure you’re eating enough starch such as rice or potatoes. You need starch to ovulate.

      Make sure you have an adequate zinc, iodine, and vitamin D (key ovarian nutrients that I discuss in Chapter 6 of my book). And finally, you might want to try Vitex, or try it again if you’ve tried it already (see my Vitex post. You’ll need to give it at least 3-4 months to work.

      • Thank you Marie and Lara for your responses.

        I did have a regular (and quite heavy) period from the age of 10 to when my period stopped due to presumably all the exercise and poor dieting practices at age 16. I’m looking forward to reading your book – I was unaware of the 100 days to happy follicles fact.

        I am currently trying vitex. It tastes like dirt – but I’m hoping it will help.

  57. Dr. Briden,

    I hope you can tell me if I’m on the right track or not. I’m 32 and diagnosed with endometriosis at age 16. Last year an MRI showed possible PCOS. I had my saliva levels tested a few months ago and I have low estrogen/low progesterone (but still labeled estrogen dominant). Cortisol is normal and testosterone level was normal/high range.

    I’ve been bleeding for the last month and I’m tired of this battle. I’ve never had a clockwork cycle my entire life besides through the use of BC which I do not use.I had an ND in the past and unfortunately I never saw much progress hence me deciding to take matters into my own hands. I’ve been on this regimen the past week. No real change yet but I have been experiencing mild cramping from time to time.
    FYI:: I am a plant based vegetarian. Very rare consumption of soy products or dairy.

    So, what do you think:
    500mg vitex 1x daily
    1/2tsp inositol
    Vitamin C 1000mg
    Magnesium 400mg
    B Vitamin Complex
    Iron Supplement

    Any feedback I’d love to hear it!

    • Hi Shae, Bleeding for one month means that you have not been ovulating, and you need blood tests to figure out why. It might be PCOS, but you don’t know until you do the blood tests. Seeing polycystic ovaries on an imaging study is not enough to diagnose the condition. You need to rule out an insulin problem, as well as thyroid and prolactin. I provide a list of blood tests in Chapter 7 of my book.

      If you do have PCOS, then Vitex is probably not the right herb. See my Vitex post.

      Also, since you’re vegetarian, you’re probably deficient in zinc, and zinc is a key nutrient for ovaries and ovulation.

  58. Hi,

    I am 19 and had been eating what I thought was healthy (low fat and low carb and a lot of chicken and vegetables) and I exercised every day. My period was every 21 days but regular and my weight is 125-130 (I am 5’6″). Last December, I tried turmeric for some mild-moderate forehead acne and took 500 mg tabs until May. My period became lighter each month and stopped completely in June, which is when I found out from my Mom that she stopped taking turmeric (for general health) because her period had stopped and she had hot flashes but was able to restore it with 14 days of progesterone OTC cream. At the end of July I had labs done and my Progesterone was 0.3, total estrogen was 79, FSH 9.3 and LH 6.81 and vitamin D3 23.9, Ferritin 50. My TSH was normal (I think 1.190). I tried a multivitamin recommended by a clerk from the local health food store in August (Mega Food Women’s One Daily) and I started getting hot flashes after a week or two of taking it. After about 3 weeks, I realized it was from the vitamin and I looked at the back and there are herbs (50 mg Ashwagandha root, 50 mg Chaste tree berry, 30 mg Cranberry fruit and 30 mg Schisandra Berry. There was also Iodine (100 mcg) as well as basic A, B, C, D, E, etc. I didn’t realize all these were in it but I stopped taking it after 3-4 weeks. That was about 2-3 weeks ago but since then I get really tired as the day goes on and no sign of ovulation or my period. I was prescribed a progesterone cream (30mg/ml) made at a compounding pharmacy to take for 25 days but I am afraid because the side effect is lethargy and I don’t want to be any more tired than I am. I am now eating meat and fats and pasta and exercising less. Is there anything I can do to bring my estrogen up without any herbs?

    Thank you.

    • Yes, turmeric lightens periods, and does have a mild anti-estrogen effect. But sounds like your biggest problem was the low-fat, low-carb diet. I don’t think the little bits of vitex and ashwaghanda in the multi would have done any harm.

      You probably just need some more time now that you’re back on fat and starches. Pasta is okay if you don’t have a gluten problem, but remember there are other healthier Gentle Carbs, such as potatoes and rice. (see my book and my Gentle Carb post)

  59. Can Celiac cause Low Estrogen? Would a profile of Low Estrogen, Low Progesterone, Low Growth Hormone, Hypothyroid, Vit D deficiency, Low Ferritin, High DHEA resemble Celiac?

    • Yes. As I state in the post, gluten sensitivity is a cause of estrogen deficiency. With my patients, I order a blood test: celiac serology or gliadin antibodies.

  60. Hullo Lara, Can you help me I am taking Bio Identical Testosterone, and Progesterone cream after having blood tests done. After my first jar the testosterone was increased as I still had my symptoms not sleeping well, vaginal dryness, low libido probably because of the vaginal dryness. P30mg/g and T3mg/g is my current doseage.

    I feel I need oestrogen particularly oestradiol the safer one added to it. I am supposed to put this directly on parts of vagina and that works sometimes but mostly it doesn’t appear to go into my skin. Dr doesn’t believe me and thinks its a joke, but my husband is taking T cream and he said his second bottle did the same thing was not absorbing either so we both now put it on our necks. I have just read this morning that cream can have the tendency to not absorb anymore and you kind of run out of places on your body to put it – which was an argument for using troches made with stevia not sugar. Anyway the mix I am on doesn’t work for me. what do you think.? The doctor I am under believes that we get enough oestrogen from plastics etc and don’t need any supplements.

    Should I go back to the lower dose of T but keep the P as it is and hopefully request Oestradiol in the hope that it may help the dryness. If so how, could I send you my latest blood tests and could you prescribe them for me?

    I used to do saliva hormone tests but found these unsatisfactory. So much so that the saliva ones were saying my Testosterone was way high and in reality with the right blood tests they found it was really low being in menopause, low in everything as we women experience once periods are no more. When I was younger I had the swollen breasts before periods, uterine fibroids etc all symptoms of high oestrogen but this would have changed once menopause hit I guess.

    To something else a compounding chemist I once knew just was on Pregnenolene as she reckoned that it was the mother of all hormones and once taking it all the others would balance out. No one else seems to mention it.
    I would love to get your feedback.

  61. Hi Lara,

    I’ve had really poor sleep for years due to hot flashes at night and Valerian is the only medication I’m willing to take chronically. It helps dampen my arousal level so I can usually fall back to sleep. However, I’ve read I should only take it for two weeks at a time. I am 56 and otherwise healthy. Do you see any problem with chronic use?

    Valerie

    • Hi Valerie, Valerian is safe for long term use, and is not addictive. You might also want to try magnesium if you have not already.

    • Flax lignans are anti-estrogenic in women (so they lower estrogen). They may have some pro-estrogenic effect in men, but I wouldn’t think it would be strong enough to increase breast size.

          • I am so devestated. I have insufficient glandular tissue/underdeveloped breasts due to high androgens from PCOS during puberty. Can you suggest something I could do that might stimulate breast development? I can’t live with this, I can’t accept this. I hate this. If it’s all about reducing Androgens, how can I lower my DHEAS? Is there any way besides herbs or pharmaceuticals?

  62. Do you think mercury in fish is overrated or a valid scare? I feel like I want more fish in my diet, but I don’t know what to believe.

    • Hi Sadie, I do think that mercury from fish a valid concern. It’s worst with large fish like tuna and marlin. Sardines are a good option!

  63. Hi Lara, Thank you for your wonderful blog. I’m 40, had a child very easily at 36 but am now dealing with low AMH (.8 last September, .24 in March), increasing FSH (now 15) and fertility difficulties in trying to conceive my second. Ive been trying to conceive for over a year and doing acupuncture for 5 months. I believe I’m entering peri-menopause. About 20 months ago, the first two days of my period became much heavier. In the last six months, I’ve noticed skin drying, increased wrinkles, increased urgency to urinate, mood fluctuations before my period (which I never had before) and terrible sleeplessness (especially early morning waking). I do ovulate regularly and have 28-30 day periods. Last year, I tried vitex (took the amount suggested on the tincture bottle) and after 3 months, I felt amazing. I was relaxed, had an even mood, slept wonderfully and felt all around great. However, when I went to my fertility doctor for my usual early sonogram- they told me nothing at all was happening. No eggs were growing and I was nowhere near ovulation. I panicked and stopped taking it immediately. Things returned to normal and I made an egg. Now, after 8 months more of no success with pregnancy (I had a 6.5 week miscarriage), and ongoing sleep issues- I’m wondering if I should try vitex again. My questions are: would you suggest I try it again with a lower dose and taking five days off (I didn’t do that before)? Would I be risking not making eggs or ovulating if I tried it again? Is there another herb or major dietary change you’d recommend? Thank you. -Sarah

  64. Dear miss lara, I’m 30 years old, 163cm, 55kg, I have acne on my back and chest, hair loss, irregular menstruation 55 days cycle. Am I PCos ? Thank you.

    • A long cycle like that does suggest PCOS, but the only way to confirm is with a blood test. (For a list of tests, please see Chapter 7 in my book.)

    • Interesting question. In truth, it would look very different depending on the type of PCOS (as I discuss in my book and my 4 Types of PCOS post). Insulin-resistant PCOS-sufferers need to strictly reduce fructose and be moderate with starch. Non-insulin-resistant sufferers may need something quite different such as an anti-inflammatory (gluten-free diet). Generally, I think all human beings do best on a diet of mostly vegetables (starchy and non-starchy) and small amounts of animal products. Generally, I think it’s okay to have non-gluten grains such as rice.

  65. Dr. Lara,

    I was Vegan for this past year except for cheating & eating meat once or twice a month. I have been eating meat regularly for the last month & my period is heavier, more liquid and painful. Any insight as to whether this is good or bad?

      • No, I haven’t reintroduced dairy. I have been eating a lot of red meat, though, because my blood work showed my ferritin level was 27, which I thought was too low. I figured red meat would help. I also had low Estrogen on my 24 hr urine test. Since eating meat I feel hotter and sweatier, too.

        I have a separate question. I have Candida overgrowth and I am sure my good populations are low since I have taken far too many antibiotics in my life. Is taking probiotics pointless? Is fecal transplant the only option to repopulate?

  66. Cant wait for the article on estrogen excess! Does your book cover that in detail? If it does I will go order it right now. 🙂

  67. There has to be a reason you’re not ovulating. If you eat sufficient food including fat and starch, then your BMI is probably not the problem. Have you been assessed for gluten sensitivity? For thyroid? I discuss hypothalamic amenorrhea in Chapter 7 of my book.

  68. Hi Lara!

    Thank you for the informative article. I have very low estrogen due to having had hypothalamic amenorrhea for two years (and counting!). I have been treating the primary cause of my amenorrhea for the past 18 months with no results, and the low level of estrogen in my body is definitely taking its toll. Do you recommend anything specific or have any thoughts regarding my situation? I am 18 years old and have never ever been on any form of hormonal pills or treatments other than natural herbs.
    Thank you!!

      • Hi there! Thank you for responding! My BMI is (I think) 19. I”m 5’9″ and weigh about 130-140 pounds, I don’t weigh myself regularly. I’ve never been a vegetarian and I eat lots of healthy fat! I was getting my period for about 3 years before I developed amenorrhea and they were never completely regular, but fairly normal. 🙂

          • Oh! I always thought that a BMI of 19 or 20 was considered normal. I don’t feel underweight. I have the problem where I carry my weight in my middle section due to my hormonal imbalance and high cortisol levels. I don’t diet in any way, I simply try to eat a healthy, nourishing, whole foods diet. I eat plenty of healthy fats and starches and try to listen to my body’s signals from day to day. Have you written a post on hypothalamic amenorrhea? Thank you for your wisdom. 🙂

  69. Hi Lara

    I have critically low levels of testosterone , low estrogen, progesterone dhea and an under active thyroid and adrenal fatigue

    Is it normal for one person to have so many deficiencies ?

    Judy

  70. Dr. Lara,

    Do you think starches should be eliminated when one has candida?
    Also, is it true that gluten–the actual protein itself, specifically feeds candida?
    How in the world can one go about healing their candida and their leaky gut? I am so lost. I have PCOS and figure I should consume grains and other starches for their Inositol, etc. However, I don’t know if that is advisable with candida. Might I propose a future blog post dedicated to candida and leaky gut? I really think both can set off hormonal imbalance.

    • I speak about leaky gut (intestinal permeability) in my book. Yes, it affects hormones. There are lots of ways to heal leaky gut including avoiding antibiotics, correcting SIBO (small intestinal bacterial overgrowth), and Yes, avoiding gluten in some cases. Gluten can be inflammatory and damage intestinal tight junctions. It’s a problem for some people more than others so I look for gluten symptoms and I test patients for gluten sensitivity before I recommend no gluten. Gluten doesn’t feed candida.

      And No, you don’t have to avoid all starches. In fact, avoiding starch can cause real problems for some women (see my Gentle Carb post).

      I don’t really think in terms of candida anymore. Candida overgrowth is just one part of dysbiosis, or a problem with the intestinal bacteria (microbiome). I now think more globally about the microbiome, and how to avoid insults to it (antibiotics and birth control pill), and how to give it what it needs (vegetable starch).

  71. Hi Lara, Thank you for another informative article. Do flax seed, evening primrose oil, black currant and even fish oil work in the same way that soy does with relative estrogen deficiency? Confused about fatty acids relationship with estrogen. … Thanks for your insight.

    • I wouldn’t say that fatty acids have a direct impact on estrogen, although certainly our omega 3:omega 6 balance affects inflammation, and therefore our response to estrogens, and our ability to detoxify them (I’ll discuss that in the next post). Flaxseeds also contain phytoestrogens called lignans, which are milder than soy’s isoflavone phytoestrogens. As I explained in my Soy post, phytoestrogens are anti-estrogenic in menstruating women, but mildly pro-estrogenic in men, children, and post-menopausal women.

  72. Wonderful article! I think Valerie was implying that she’s been menopausal for 12 years, since she was 42. That would make her 54 now, same as me.

    I went off birth control pills 3 1/2 years ago, just one month I was taking them and the next I wasn’t. My GP did blood tests that showed I was menopausal and didn’t need the pills. I wasn’t ready for the onslaught of symptoms, though. Of course, the hot flashes got mean and the sleeping was erratic. But what really hit me was my muscle weakness and pain. The larger the muscle, the worse it was. My legs were the worst. For nearly a year, I could barely get up from a squatting position. Getting things off the bottom shelf at the grocery store left me pulling myself up the shelves like I was climbing a ladder. I couldn’t lift things, I had trouble holding my arms up for any length of time. It hurt to stand from a seated position. God forbid, I had to get up from the floor for some reason. It took a lot of effort and was quite painful! I was so afraid that this was a permanent state of affairs. I couldn’t fathom how I would live like this for the last decades of my life. And why was no one else complaining of this?

    That has faded, thank God! I think I took my last pill January 2012. The peak of the muscle weakness and pain was probably June 2012. Perhaps it was gone by January 2013. I don’t recall exactly. It faded gradually. My current health is better, although the vaginal dryness is a reality. I’ve also had two bladder infections in 6 months, after having only one in my life, 30+ years ago. I don’t like taking prescription medications, particularly antibiotics. But those bladder infections left me no choice after trying to solve it myself with massive doses of cranberry over two weeks and in the end I was peeing blood. Not fun.

    Is there any answer for me? I don’t want to expose myself to any risks of cancer. There’s enough of that in my family to put a scare into me. But I would love to not have to deal with bladder infections forever. I am married and have a very active intimate relationship with my husband.

    • Hi Marie, thanks for sharing your story. I think it’s really shocking that menopausal women are expected to endure symptoms like you describe. We’re in this funny time of thinking all HRT is bad, therefore denying women a natural hormone that could really benefit them. This was discussed in this Guardian article from April.
      https://www.theguardian.com/healthcare-network/2015/apr/01/lets-talk-menopause-because-we-are-failing-13-million-women

      Put simply, estradiol supplements are not the cancer risk we’ve been led to believe. The real situation is much more nuanced than that, as explored in this article:
      https://www.nytimes.com/2010/04/18/magazine/18estrogen-t.html?_r=0

      The answer for you is probably an estradiol vaginal cream. I’m a big fan. It will solve your bladder issue and improve your vaginal tone and libido. It is such a low dose that I do not think it is a cancer risk.

      Put it this way, I’m coming up to menopause myself (I’m 45), and if I find that I need an estradiol cream for dryness or libido, then I am going to use one. I will not even hesitate.

  73. I have heard that melasma is due to low estrogen… is that true? I’ve only seen it in one place and really couldn’t find much additional info on it.

    I have some melasma, but I would NEVER expect low estrogen based on my charts or any other symptoms…

  74. Thanks for the good info. But what if you’re already in menopause for 12 years since age 42 and still having hot-flashes and terrible insomnia secondary to them. Aren’t I past the window for taking the hormones? Also isn’t Black Cohosh a risk in that if you develop breast CA, a good study found you were xx times more likely to have it metastasize if taking this herb? Any suggestions for the outliers like me?

      • Hi again Lara,

        It’s Valerie. (I am actually 56 years of age. Had my daughter at 42, breastfed her for a year and then went straight into menopause!).

        Thanks for the article, but I was not suggesting that Black Cohosh caused CA, but rather that if, unbeknownst to you, you did have it, there maybe an increased risk of metastatic spread. There was a very good study showing this with rats, but it does not appear to have been studied in humans to my knowledge and the article you referenced doesn’t address this concern either.

    • Hi again Valerie, Yes, sorry my misunderstanding about your age. The consensus at this stage is that black cohosh is safe. Also, I still think low dose estradiol is an option into mid-fifties. Please see my reply to Marie’s comment below.

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