What sort of hormonal imbalance is this?


What can I do about hormonal migraines? How can we stabilize our weight on the keto diet? And what kind of hormonal imbalance do these symptoms imply?

Get the answer to these questions in this week’s Q&A with the fertility specialist Dr. Fox:

What sort of hormonal imbalance is this?

What could be going on hormonally with the following scenario? Any suggestions?

No signs of PCOS; endometriosis and fibroids ruled out, hormone blood tests supposedly ‘normal’, normal weight, but:
severe PMS – sore breasts from ovulation onward, tension, irritability and depressive mood symptoms, fatigue, premenstrual headache, period cramps, heavy and long periods, and spotting/light bleeding for 7 days before the onset of the period, sometimes spotting for almost the entire luteal phase.

Age 40 and the PMS started in the teenage years and worsened over the last 10 years. Estradiol patch caused intensified feelings of tension, anxiety and irritability. Oral bio-identical progesterone during luteal phase improved mood symptoms but didn’t help sore breasts or luteal phase bleeding.


Dr. Fox:

My belief counter to traditional medical teaching is that PMS symptoms result from low estrogen. This often stems from hypothalamic dysfunction from over exercise or repetitive hypoglycemia due to high-carb diet or starvation diets etc.

This would likely explain the teen symptoms if they were significant. Women with significant period pain most likely have endometriosis that also causes significant estrogen decline and PMS symptoms about age 35 or so. In patients already compromised by hypothalamic dysfunction, the symptoms do start late 20’s or 30ish. For the latter group that sounds like your story, estrogen levels are often close to zero by age 40.

Many people don’t absorb the patch well and the patch may only contribute a level of 15-30 pg/ml when I usually try to boost people up to 150 or so to feel better (based on my clinical experience more than scientific evidence). It is very difficult to interpret labs when the ovaries are present and producing estrogen as well. My approach to this is to take higher-dose oral estrogen for a cycle or two as a test to see if this really is an estrogen deficient problem. Often when the level comes off near zero to a low to mid range, the symptoms often worsen paradoxically.

Progesterone further lowers estrogen but does blunt many of the low estrogen symptoms, causing many a false sense of security and improvement. Underneath that however, the low estrogen may be causing many negative things to happen and long term use would eventually uncover these issues.

Today it is hard to find a practitioner who will try higher doses of estrogen to figure this out.

Hope this helps.

Help with hormonal migraines, please!

I am currently following a LCHF diet and have had a great reduction in the number of headache days per month. Hooray! I took sumatriptan (Imigran) for about ten years but haven’t taken any medications since I started the diet in July, in order to eliminate rebound headaches, and I am really seeing the benefits.

I am however still suffering greatly when I get the hormonal migraines 2-3 times per month (at the beginning and end of menstruation and then at ovulation). I have recently started taking Premular (extract of Chaste tree Ze 440) to balance the hormones. I don’t seem be having any success preventing or treating these headaches, despite the Premular, plus stress reduction, and fasting and cold packs during the headaches.

Do you have any further suggestions on how to put an end to the misery of the hormonal headache??! Any help would be greatly appreciated.

Thank you,

Dr. Fox:

Migraines seem to me to be caused by three things:

  • Low blood sugar or falling blood sugar as would be seen on a high-carb diet and why you are now better
  • Stress
  • Falling or low estrogen

Many, many women we see today even in their 20’s are experiencing low estrogen for various reasons as I have enumerated in many answers on this site. You need supplemental estrogen most likely and the forms that will work best are the non-oral methods.

The patch is the easiest but often does not increase the levels enough. Try it first and if it works great. Vaginal delivery with a 0.5mg tablet broken in 1/2 twice a day works well.

Levels must be checked, looking for high levels > 225 or so. If so, decrease the dose but stay with twice a day. This is especially helpful with women who also have vaginal dryness or urinary frequency and urgency and should be the preferred method in these cases. Lastly, a once per week injection of low dose 1-2mg per week also works well.

These are unconventional approaches, so it might take some time to find a practitioner willing to work with you and prescribe these forms of estrogen. Then some assessment of why the estrogen is low would be important. It could be something as simple as age.

Best of luck.

How we can stabilise our weight on the keto diet?

For example, if I lose 10 kg (22 lbs) how can I keep it as that to not losing or gaining more?


Dr. Fox:

The keto diet is unique in that as long as you maintain the approach, you will should not lose too much weight.

Staying on the diet does not push people into an abnormally low range. This is contrary to starvation diets where people can lose below an ideal weight. If you reach equilibrium above your ideal body weight, your stress/cortisol system could be inhibiting you. Caffeine also activates this system.

Over time however, with age, the metabolic system becomes dysfunctional and you would see slow weight gain, all other things equal.

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