Relief from Hormone Hell: Herbal Support for PMS and ...wintergreenbotanicals.com/wp-content/uploads/2016/... · usually calls for a trip to the hospital, not an astringent tea)

Maria Noël Groves Hormone Hell Relief www.WintergreenBotanicals.com

Relief from Hormone Hell: Herbal Support for PMS and Perimenopause

Wintergreen Botanicals, LLC Maria Noël Groves, Clinical Herbalist Allenstown, NH (Near Bear Brook State Park) 603-340-5161, [email protected]

www.WintergreenBotanicals.com

MY BASIC DISCLAIMER: The information in this handout has not been approved by the FDA and does not in any way intend to diagnose or prescribe. Always consult with your health practitioner before taking any remedy. Above this, I also recommend that you…

1. Research an herb in at least three good sources before ingesting it (see website for sources), 2. Listen to your body/intuition to determine if an herb resonates or doesn’t resonate with you. 3. Take proper steps to ensure that any wildcrafted or cultivated plant is what you think it is, AND 4. Check with your pharmacist for herb-drug interactions if you take prescriptions.

Get up close and personal with the female reproductive cycle and learn how to use herbs to manage imbalances including raging PMS, perimenopause symptoms, mood swings, brain fog, cramps, infertility, and period irregularities. Learn how to craft effective customized formulas. (Also check out my book, which will be available for sale at the symposium, and you can also order your own copy by clicking on the image at right.)

WOMEN’S REPRO BASICS When we talk about the woman’s reproductive system, we’re often talking about one or more of these basic components: the organs and tissues, the hormones, and/or energetics. Let’s look at each of these components, how they fit together, and how to use herbs to influence them, ultimately creating a well-rounded formula for the individual Reproductive System Structures Our ovaries hold follicles (eggs to be) and house most of the month-to-month activity in the repo system. Each month, a follicle is chosen to be “queen” for a month, producing estrogen during the first half of the cycle, then releasing as an egg during ovulation to travel down the fallopian tube to either make a baby in the uterus or leave the body via the vagina. Once the “queen egg” has left, the empty throne (corpus luteum) produces progesterone. It takes approximately four months of “grooming” a follicle once chosen from the pool of primordial follicles to be in the running as a future egg. Even though the majority of the female system is internal, we do have external labia and a clitoris.


Basic Needs of These Structures and Tissues: Good Nutrition: Your body needs good, well rounded nutrition in order to function. Simply taking a good multivitamin and omega 3 fatty acids improve fertility by about 50 percent! Another more multifaceted program in the Foresight preconception program led to conception (within 1-3 years) in 86% of couples who had previously been considered infertile. The Foresight program focuses on many factors including a healthy diet, avoiding alcohol, caffeine, and smoking, addressing seasonal and food allergies and infections, toxin exposure, and more. With women, we also tend to look at specific nutrients like iron (when there is excessive menstruation or anemia - think of meat, leafy greens, nettle, yellow dock, dandelion leaf and root) and calcium (when we lose bone density to to estrogen deficiency in perimenopause - calcium-rich herbs, nettle, red clover, oat straw, leafy greens, bone-based foods, phytoestrogens). Four Month Rule: Based loosely on the time it takes for a primordial follicle to become an egg, it usually takes about four months for nutrient and herbal therapies to really kick in, although you may notice improvements earlier than that. Tissue Toners: Gentle astringents, most often in the rose family (YARFAs - Yet Another Rose Family Astringent, coined by Michael Moore), help tighten and tone the tissues in the reproductive system. Red raspberry leaf has been shown to strengthen the muscles of the uterus. These astringents can also dry up excessive secretions and mild bleeding (to borrow from Jim McDonald... copious bleeding usually calls for a trip to the hospital, not an astringent tea). Rose blossoms and lady’s mantle are also traditionally used to ease excess “oozing” and bleeding and to strengthen prolapsed organs, usually as teas. Cinnamon can be useful where there is excess menstrual bleeding and cramps (it’s drying) whereas ginger will also ease cramps yet increases blood flow to and from the uterus. Blood Flow: Many herbs help increase blood flow to the uterus when menses are late, spotty, brown, and sparse. Ginger is pretty amazing! Also consider angelica, lovage, motherwort. Dong quai increases blood flow to the uterus while also synergizing estrogen and acting as a building, nourishing, semi-adaptogen tonic; I’m most apt to use it where there is estrogen and overall deficiency signs - cold, spotty periods, thin, anxious, anemic. Moisture Support: This tends to be a problem when the tissues start to dry up - most often an issue as estrogen dwindles in perimenopause and after menopause. Boost hydration and good fats internally. Taking shatavari increases cervical mucus and provides some phytoestrogen action. Other estrogen-support herbs may also help. And you can also use mucilaginous and/or oily remedies directly on the area (just be aware of the potential for infections and contamination). A good lube and plenty of foreplay helps! Cramp & Pain Support: First, look at magnesium and B vitamin deficiency. Cramp bark and other Viburnum barks can help relax the uterus symptomatically to ease pain - a miracle for some, but quality/potency varies, and it doesn’t work for everyone. Other antispasmodics include wild yam root, angelica root, black cohosh root, and dong quai root. Both ginger (increases bleeding) and cinnamon (decreases bleeding), encapsulated, have been shown to reduce menstrual cramps. As a long-term tonic, especially in fibroids, cysts, and endometriosis, consider black cohosh, fenugreek, and shatavari, and also watch things like hormones in meat and dairy as well as caffeine and other xanthine compounds (coffee, black tea, chocolate... green tea is usually helpful, though). It’s usually better to manage pain if you start taking herbs early or before pain kicks in than at the height of pain.



Hormones & the Endocrine System Much of what we think of as “reproductive function” is governed by hormones. Hormones are the chemical messengers of the endocrine system, which are (mainly) produced in endocrine glands, excreted into and traveling via the blood, exerting an impact on cells throughout the system and body, and ultimately metabolized by the liver. Many of our hormones work on a relay system, and the female reproductive hormones are prime examples: In the brain At the target gland Hypothalamus Pituitary Primary Hormone Gland That Produces It GRH (gonadotropin RH) FSH (follicle SH) estrogen Ovary (follicle) GRH (gonadotropin RH) LH (luteinizing hormone) progesterone Ovary (corpus luteum) “releasing hormone” “tropin/tropic”/ “stimulating hormone” Hormonal Shouting Matches: We see the stimulating/pituitary hormone get high often when the primary hormone is not being produced efficiently. You can think of this as the brain yelling at the ovaries. A good example is surges of high FSH in perimenopause due to fewer/less healthy follicles producing less sufficient amounts of estrogen, which can result in hot flashes as well as fertility issues. We see increased surges of LH during periods of stress because the body wants the corpus luteum to produce more progesterone for use as a mood booster and to convert into stress hormones... but it means you “run out” of progesterone before the end of your cycle, leaving you with raging mood swings and a weak immune system premenstrually - basically everything falls apart and all hell breaks loose. (If this is you, consider vitex plus stress support and know to take really good care of yourself prior to and during this time - get enough sleep, take your vitamins, adaptogens and nervines, maybe some elderberry syrup and lemon balm, etc.) Progesterone insufficiency issues also occur midcycle on months when you don’t ovulate (no ovulation, no corpus luteum, no progesterone). Stress and cycle support helps, as can simply taking progesterone (bioidenticals from a doc, OTC progesterone cream) in extreme cases, but remember that perimenopause is a normal part of life. Not all the reproductive hormones work this way, though. Even though we think of oxytocin as a reproductive hormone due to its primary functions (contractions, climax, let-down reflex...) is produced by the brain’s pituitary gland and acts as both a hormone and as a neurotransmitter-like neuropeptide. Prolactin (which encourages milk production) is also secreted in the pituitary. I tend to work primarily from a hormone perspective in my clinic, and these are some useful ways to think about the herbs that have overt influences on the hormone: Estrogen Support Main activity from days 1 through 14. Estrogen is produced in the follicle (egg) in the ovaries before ovulation primarily. It has mood-boosting, bone-protective, immune-boosting properties, and its primary role is to build up bloody uterine lining. Bear in mind that more often we see estrogen dominance, not estrogen deficiency, thanks to cranky hormones in our food and environment and stored in our fat cells. • Dong Quai (Angelica sinensis) specially prepared roots (crude roots aren’t the same) - Useful as

decoction (traditional), capsule, or tincture (I use dry 1:5, 50-60%). It’s traditional to use this in formula, not as a stand alone, usually with adaptogens and tonics.


• Estrogen synergist, blood-building, reproductive adaptogen. Specifically used for those who are deficient - cold, thin, anxious, anemic, scanty spotty periods. Improves circulation to the uterus.

• Michael Moore took part in unpublished research on dong quai that found that it increased natural estrogen levels/activity but did not do anything if there wasn’t estrogen to work with. It is not a phytoestrogen.

• Can aggravate bleeding/menstruation. I avoid when estrogen dominance is present (heavy flow, short cycles, often in overweight women), too.

• Black Cohosh (Actaea racemosa syn Cimicifuga racemosa) roots - I use fresh homegrown roots tinctured 1:2 in 95% alcohol to ensure quality and identity (adulteration is a BIG issue, leading to liver toxicity), and before I could harvest my own I bought organic from Mountain Rose (dry 1:5, 50-60%). I can use about half the fresh cohosh in formula and get the same or better results, usually 10-20% of the formula, 2-4 ml total formula 1-2x/day. Most of the studies on black cohosh were done on Remifemin, which does not appear to have been affected by adulteration.

• Improves estrogen balance, regulation, brain-ovary communication?, not phytoestrogenic • Commonly used and studied for perimenopause, menopause, hot flashes, also RA and OA

arthritis, black cloud depression, uterine relaxant for cramps • Uterine Fibroids: shrinks them - % volume change = 30% decrease compared to just 5%

with meds; 70% response with cohosh vs 36% with meds. 40 mg/day for 3 months. • PCOS & Fertility: better FSH/LH ratio, progesterone levels, more pregnancies vs clomid.

40 mg/day from day 2-12 for 3 consecutive cycles. • Maybe also Damiana • Phytoestrogens - weaker than body’s natural estrogen but binds preferentially to receptor sites

• Shatavari (Asparagus racemosus) roots • Phytoestrogenic but also anti-inflammatory (affinities for the gentital-urinary and

digestive systems), demulcent, moistening, improves mucus/slippery/cervical fluid, diuretic, adaptogenic and mood boosting, libido enhancing, fertility support, perimenopause/post menopause support... for the woman with 100 husbands, an herb with 100 roots, for 100 uses...

• Legumes: Beans (my preference), soy (strong, not my fave, preferably whole, fermented), red clover flowers (weaker) - bone support, menopause, likely anticancer

• Lignans: Flax - breast tenderness, cancer support (also high in fiber and omega 3s) • Mint Family Herbs: Sage, lavender, motherwort, mint... (can have anti-androgen effects

for men) - we’re still getting to know these plants as phytoestrogens • Fenugreek (Trigonella foenum-graecum) seeds, ground up in food, tincture, or extract capsules

• Very complex plant with many applications and considerations for the endocrine system. This is a phytoestrogen, steroidal saponin, high fiber/mucilage plant, demulcent, anti-inflammatory, and anti-diabetes herb.

• Reproductive hormone regulation, contains steroidal saponins, possibly useful in menopause, used to promote milk flow, maybe oxytocic and uterine stimulant. 900 mg seed extract capsules 3x/day for first three days of menses, 2 consecutive cycles, significantly reduced menstrual cramps.

• In one PCOS study, two 500 mg fenugreek extract capsules (Furocyst) for just three months completely eliminated cysts in 36% of women studied; cyst size was reduced in 46% of the study participants; 71 percent returned to normal menstrual cycles; and 12% got pregnant.

• Several studies support its use in diabetes (both type 1 and type 2), high cholesterol, metabolic issues. Doses range from 2.5 g to 50 g, caps, alcohol extract, powder.


• Also demulcent, anti-inflammatory, used for allergies. • Fenugreek gives people maple-scented urine, which is harmless. When taken as a crude,

high-mucilage form, can cause digestive upset and delay absorption of other herbs or drugs taken at the same time and should be spaced apart by an hour or more. Fenugreek allergies have occurred, with chickpeas and peanuts (also legume family seeds) as a common cross-allergens. It should not be used in pregnancy, but it is commonly used as a nursing stimulant (increasing prolactin). Mouse and rat studies suggest it decreases T3 (active thyroid hormone) and increases T4 (inactive thyroid hormone).

Oxytocin Support Even though oxytocin is a hormone produced by the brain (not in the ovaries or testes), it ties in closely with reproductive function in both genders. Consider this the “let go” hormone. It surges just before/with menstruation, ovulation, climax, ejaculation, uterine labor contractions, breastfeeding let down reflex, etc. We also get a surge of oxytocin when we have skin-to-skin contact with the ones we love, snuggle, hug (20 seconds!). It’s a mood booster and helps us make loving connections with partners, babies, friends. Stress directly inhibits oxytocin production. We can use oxytocin synergist herbs (as well as sexual stimulation, snuggling, hugs, stress reduction, mind-body balance, and libido-enhancing adaptogens) to help rekindle this important hormone. I do not recommend using these herbs to induce labor or abort pregnancy (unless maybe if you’re working with a qualified midwife or herbalist who specializes in this area). • Cotton (Gossypium spp) fresh root bark tincture - yes, same plant as cotton clothes, but we’re

using the root, and go organic! • Thank Michael Moore for this one! Although traditionally used as an abortifacient, it’s

more likely an oxytocin synergist. It can be used to help with folks who want to get “in the mood” but are having a hard time getting there. I also use it for a three days mid-cycle (alongside other formulas to support estrogen/progesterone) to encourage ovulation and more regular cycles. Tincture, about 30 drops. Herb Pharm and Ginger Webb sell the tincture.

• Blue coshoh is also an oxytocin synergist of sorts, but I don’t use this plant for several reasons.

Progesterone Support Luteinizing hormone (LH) from the brain tells the corpus luteum (post-ovulation egg shell) to produce progesterone. It has mood boosting, immune supportive benefits and helps specialize the uterine lining to prepare for pregnancy or for easy sloughing off during menstruation. Reproductive wobbles, especially in menopause when ovulation may not occur, can cause a drastic reduction in progesterone. In stress, your brain may over-stimulate progesterone synthesis, causing the corpus luteum to run out before your cycle is ready to begin, which can cause all sorts of issues (PMS, immune weakness, etc.). Stress may also favor the production of stress hormones over reproductive hormones. Note that LH stimulates testosterone production in men. Our progesterone supportive herbs generally work to improve brain-ovary communication, not to actually provide progesterone. I almost always include stress-supportive herbs in the formula and protocol. Progesterone creams and pharmaceuticals can provide progesterone directly (I don’t use them, just saying). Wild yam’s steroidal saponins cannot be used to make progesterone, estrogen, and other reproductive hormones unless processed in a lab. • Vitex/Chaste Tree Berry (Vitex agnus castus) berry/seeds, I use dry tincture, but you can also do

caps.


• Brain-Ovary communication, progesterone support/luteal phase/LH and regulation • I always combine with stress support/adaptogenic herbs and ideally also liver support (ie:

schisandra) • Studied for PMS, fertility, irregular cycles, mastalgia (80% good response, 60% pain

reduction) • Makes some women pissy, moody, depressed (and improves it in others)

• Maca (Lepidium meyenii) roots • Adaptogen with a reproductive health affinity for women and men. Seems to improve

brain-ovary communication to support progesterone and testosterone particularly. Boost libido, energy, may help in menopause and andropause, fertility. Highly nutritious, rich in protein and various minerals. Tasty, sweet.

• Cruciferous vegetable, contains low-level goitrogens which may or may not be a problem. Some people prefer it cooked or gelatinized. Not a concern with the tincture.

• Maybe also Damiana Energetics Beyond (alongside or instead of) the classic A&P, we can look at the goings-on of the reproductive system in energetic terms, looking at the individual person, the condition, and any other factors. Do we see signs of heat or cold? Excess moisture (boggy or leaky) or dryness and atrophy (see the works of Jim McDonald and Matt Wood)? Are they andrenergic, anabolic, or showing thyroid stress (see Michael Moore’s constitutional system)? Is the person showing agitation of pitta, kapha, or vata (Ayurveda)? Perhaps you have a traditional Chinese medicine or other framework you’re working in. Energetics are not hard and fast rules but suggestions. They’re most useful when something really stands out in a person, not boxes you force people into. These clues can help you narrow in on the herbs for formula likely to work best for the individual. Here are some herbs to think of from an energetic perspective:

• Shatavari: moistening, phytoestrogenic, tonic, adaptogenic, anti-inflammatory • Hops: intensely cold, phytoestrogenic, anti-inflammatory, sedating • Sage: intensely drying (sweat, hot flashes, breast milk), phytoestrogenic • Damiana: cooling, aromatic, nervine, mild hormone strengthening/balancing activity • Blue Vervain: grounding, bitter relaxer for the “wind” type A, andrenergic, driven person • Schisandra: drying/toning, astringent for excess secretions, adaptogenic, liver tonic • Vitex: drying, strengthens progesterone • Maca: sweet/tonic, cool, adaptogen, nourishing, mild hormone strengthening/balancing activity • Generally moistening: marshmallow, slippery elm, licorice • Generally cooling: most bitters • Generally heating: warm spices, ginger, cinnamon, cayenne, black pepper • Generally drying: astringents, cinnamon, alder, schisandra, rhodiola (bitters and diuretic or

water-moving herbs tend to help drain stagnant fluids in boggy tissues) What’s Stress Got to Do With It? Our reproductive hormones are tremendously influenced by stress! Much of what we think of as “stress” is also a product of the endocrine system (cortisol, adrenaline), even though there is also quite a bit of influence and overlap with the nervous system and its neurotransmitters. Various hormones utilize similar base structures and chemical metabolism pathways in the body, and stress is a greedy, greedy thing. Cortisol, estrogen, and progesterone (as well as aldosterone, testosterone, DHEA, and a few others) are all steroid hormones, which use cholesterol and pregnenolone as base compounds or


synthesis. This means that when the body is focused on stress, it can alter the way other hormones are produced. Focus gets shunted to cortisol production, and progesterone is also used as a precursor to cortisol. The thyroid can also get into the mix because being hyper or hypo thyroid stresses the body. And stress as well as the sympathetic “fight or flight” response directly inhibit the function of other hormones, such as oxytocin (which is why it’s so hard to be in the mood - especially for women - when you’re totally stressed). Of course stress isn’t always the underlying culprit, but it often is... or at least a factor. If stress, anxiety, insomnia, etc. are present, it’s a good idea to incorporate herbs and lifestyle changes into the protocol and/or formula to support this. The formulas I create for my clients with reproductive “wobbles” almost always incorporate adaptogens and/or nervines. Some personal favorites... • Holy Basil: stress, grief, anxiety, cortisol overload/imbalance, blood sugar imbalance, calm energy

adaptogen, nervine, nootropic. I usually use homegrown “kapoor” variety (because it grows best in my garden) as tea or fresh plant tincture (1:2, 95%) but also get results with various commercial products. Dried holy basil on the market is often of poor quality. See if you can buy from a grower like Zack Woods Herb Farm where you know it was well-tended and recently harvested. Lovely in combo with green tea for energy or lemon balm for calming.

• Milky Oat Seed: adrenal burnout, wired and tired, general nervine, anxiety, etc. Fresh milky oat seed tincture, whirred in a blender 1:2 95%. Avoid in oat allergy, some with gluten issues may react - even though it doesn’t contain gluten, the proteins are similar.

• Rhodiola: energy, brain fog, brain tonic/nootropic/restorative, zippy, when a kick in the pants is needed. Dry plant tincture (1:5, 50-60%) or modest dose capsule. You usually don’t need a lot to get the effect, and it can be obnoxiously drying and astringent in high doses... which aggravates stomach upset in some - putting it in formula and taking it with food usually helps. Even though studies show it’s useful in anxiety, I find it too stimulating for high-strung people; I’d rather go with holy basil, ashwagandha (my top two), schisandra, or gotu kola for those folks.

• Ashwagandha: calm energy adaptogen, mild thyroid booster, anti-inflammatory, immune modulating, nervine, libido-enhancing. Dry plant tincture (1:5, 50-60%), tea, simmered in bone broth or milk, capsule. Really nice herb for many people! I would avoid in hyperthyroid and possibly nightshade sensitivity, though it doesn’t appear to be an issue alongside thyroid meds.

• Schisandra: calm energy adaptogen, amazing liver protector and liver detoxification simulant, strong digestive stimulant (sometimes too strong), astringent/adrenal tonic for “leaky jing” (weak kidney chi/adrenals, stuff starts to leak out - secretions, urination, edema), immune modulator, respiratory tonic, brain tonic. Dry berry tincture (1:5, 50-60%, and if I had fresh berries, I’d use that), tea (nice with hibiscus and honey), or capsule.

• Shatavari: moistening/lubricating, anti-inflammatory, phytoestrogen, calm energy adaptogen. Very unique! Dry root tincture (1:5, 50%), capsule, or up to 1 teaspoon of powder (mixed in honey or whatever).

• Motherwort: fabulous for anxiety and panic (especially when felt in the heart), going on a rampage, mood swings, depression, stressed out/overwhelmed mothers and those who need mothering. Very cooling and possibly phytoestrogenic, reduces hyperthyroid states (but probably ok in hypothyroid), often used in perimenopause. Fresh aerial flowering tincture (1:2, 95%).

• Damiana: nervine, light antidepressant, lightly calming (good for that happy fuzzy feeling), libido enhancer especially for the tightly wound folks, studies are highly preliminary and suggest that it helps strengthen weak reproductive hormone function. I use dry (1:5, 50-60%) because that’s what I have access to in NH.


• St. John’s Wort or Mimosa: two nice antidepressant nervines! Fresh tinctures (1:2, 95%), though freshly dried mimosa bark also works well. Harvest SJW buds and flowers after a hot-as-hell week from a dry, sunny spot and refresh your tincture every few years.

If sleep is disturbed, work on stress, sleep hygiene, and consider the sedative herbs like valerian (warming muscle relaxer sedative), California poppy (strongly sedates CNS and calms spinning mind), skullcap (strongly sedates CNS and calms the oversensitive), hops (cooling and phytoestrogenic), etc. whatever seems best suited to the individual. Sleep Tea Recipe: My favorite all-purpose is equal parts skullcap, passionflower, lemon balm, and spearmint, brewed strong 1 heaping teaspoon in 4 oz teacup of hot water 15-20 minutes, sweetened with honey. Note that quality matters with these herbs, especially skullcap, which is often adulterated - grow it yourself or buy from a certified organic farm that cultivates it. The Liver Whenever you’re dealing with the endocrine system, it’s usually a good idea to incorporate some liver-friendly components into the protocol. Remember that the liver plays a major role in the metabolism of hormones, particularly regulating the levels of stress hormones in the blood and breaking them down and excreting them when they’ve done their job. Liver herbs are pretty much always nice to include in your formula, but you’ll want to key in on them if there are signs of hormone overload (common with estrogen) and increased risk of hormone-dependent cancer. Favorites here include dandelion, burdock, schisandra, turmeric, artichoke, blue vervain, and broccoli family plants (DIM, I3C, sulforaphane). In estrogen excess, also look to toxin exposure, especially xenoestrogens from plastics and other synthetic chemicals, as well as excess estrone (cranky estrogen) stored in fat cells of women who are overweight. In addition to liver herbs, avoiding xenoestrogens, and working towards a healthy weight, consider increased fiber in the diet as well as phytoestrogens - beans and flax in the diet are personal favorites - which bind preferentially to receptor sites but have a weaker hormone effect than xenoestrogens and your body’s own estrogens. Some women find that hormones in meat and dairy (both from added hormones at factory farms and natural hormones present in these foods from the animals themselves) contribute to their own cranky hormone issues. Switching to grass-fed or wild, organically raised products and/or going vegan can sometimes make issues like fibroids, bad cramps, and endometriosis disappear (estrogen regulators fenugreek and black cohosh show promise here, too), and a healthy vegan diet also lowers cancer risk. It can take a few months or the beneficial effects of these changes to become apparent. Nutrition, Digestion, Gut & Microbiome Your entire body’s health begins to suffer if you don’t eat nutrient-dense food or your digestive system is incapable of digesting and absorbing it. If this seems to be a factor, then it should be addressed or the body is going to have a difficult time doing anything well, including maintaining hormone balance. That’s a whole class or two in and of itself, but keep it in mind as you’re looking at the whole picture.


PUTTIN’ IT TOGETHER Ok, that’s a lot to think about! But it’s not really that hard to put it together into one cohesive formula and/or protocol uniquely geared to the person and her situation. Formulation Tips These are guides/suggestions, not rules, but this is how I tend to put together a formula in my clinic. I am usually working with tinctures because they work well and are easily customizable (and most of our overt hormone herbs taste nasty in tea). 20-50% Hormone Herb(s) 20-50% Support Herbs: often adaptogens, nervines, anti-inflammatory herbs, and/or liver herbs 1-15% Synergist Herb(s): these often play on energetics, such as ginger (warming, pain/inflammation), nutmeg (calms nerves), cinnamon (tightens, sugar control), cardamom (digestion), rosemary (circulation, inflammation) When there are cycle wobbles, I may make 1-3 different blends: Day 1-14 blend focused on estrogen balance and other needs during the first half of the cycle. Dose 2-4 ml 1-2x/day. Day 12-14 cotton root bark (not always). Dose 1 ml/day Day 14-28 blend focused on progesterone balance and other needs for the second half of the cycle. Dose 2-4 ml, 1-2x/day. Or I might just incorporate my hormone herbs into one formula that the person takes all month long. This is a lot more convenient for me and my clients. 2-4 ml, 1-2x/day. If this doesn’t seem to be making enough impact after about 3-4 months, then we will consider reformulating and often switching to 2-3 blends throughout the cycle. I’ll often also recommend a tonic tea (good spot for tissue toners, liver herbs, nutritious herbs, nervines, adaptogens... depending on what is needed) and one or two diet/lifestyle changes. This also depends on what seems appropriate for the client, including what herbs seem best and how they’re best taken, and what the client will actually do. If they’ll never take a tea, I’m not going to make them a tea. I’ll give some specific examples in the protocol points below.... Specific Considerations & Formula for Specific Hormonal Concerns PMS: Cycle wobbles, raging mood swings, stress is often an underlying factor, pulsing progesterone too quickly so that you “run out” before the cycle is done, leaving mood and everything more vulnerable (more prone to illness/infections/rashes...) • Key Herbs: Vitex + Adaptogens and maybe also nervines and antidepressants (watch to see if

vitex makes it worse) • Sample Formula:

• 40% Vitex (could sub Maca if Vitex aggravates mood) • 20% Damiana or Mimosa or St. John’s Wort • 15% Holy Basil or Ashwagandha • 14% Motherwort or Schisandra • 1% Nutmeg


• Diet/Supplements: Multi + B Complex, Omega 3s in diet (ideally) or as supplement, clean diet, balancing complex carbs with enough protein (blood sugar wobbles can be an underlying factor in mood issues)

• Lifestyle: Stress management! Perhaps Andrew Weil’s 4-7-8 breathing exercise (video and directions online), meditation, daily walks in nature, saying no more often, valuing personal needs and down time. These lessons can take time, we plant seeds and give reminders and gentle nudges at every follow up. Also, how’s sleep?

Infertility: This can be caused by a diverse set of issues and can be difficult to correct depending on the individual situation. However, there are some safe, general approaches that can be beneficial and effective for many women. It helps if we know why a woman is not conceiving or holding a pregnancy. Is all the plumbing working? (Uterine and/or visceral massage can be helpful here.) Is she ovulating? (If not, follicle care and cycle support as well as tribulus may help). Is the progesterone phase holding long enough to support pregnancy? (If not, vitex plus stress and overall cycle support often helps.) Is she well nourished? Is she eating foods she’s allergic or sensitive to? Is there an underlying thyroid issue? Are cysts, PCOS, or endometriosis getting in the way?... • Key Herbs: This can vary widely but vitex to support progesterone and lenthen the cycle and

shatavari to support estrogen, uterine wellness, and cervical mucus are safe and useful herbs, either as stand-alones or in formula. I’m a little iffy on tribulus, but it does seem helpful for older women with high FSH.

• Diet/Lifestyle: See “Good Nutrition” on page 2 of these notes. Hot Flashes: When the brain yells down to the ovaries to pick up the slack, we see high FSH but low estrogen, and these surges can cause hot flashes. Stress often makes them worse, and there may also be dietary factors. Interestingly, non-western cultures get the hormone wobbles without the symptoms... could toxin exposure or crappy diet play a role?? • Key Herbs: Phytoestrogens and estrogen synergists. Black cohosh is my favorite, but also consider

hops (sedative!), red clover, sage... In addition, sleep support may be necessary for nights sweats (hops, California poppy, skullcap....). Adaptogens. Liver Support.

• Sample Formula: • Black Cohosh 20% • Ashwagandha (calm energy) or Rhodiola (drying, brain boost, zippy) 20% • Schisandra 20% • Maca 15% • Motherwort or Damiana 15% • Dandelion Root or Burdock Root 10% • Sage 5%

• Diet/Supplements: More beans (maybe soy, but I prefer other mixed beans), ideally daily. 1-2 servings of broccoli-family foods daily (mainly cooked if there is hypothyroidism), possibly 1 tablespoon ground flax daily on food/in smoothies. Gradually introduce and work up the dose to help the digestive system/microbiome adjust to all these fiber sources if gas/boating/etc are a concern.

• Lifestyle: Stress management and all that was mentioned for PMS if stress seems to be an underlying factor.

Vaginal Dryness: Common in perimenopause and post menopause due to less estrogen influence, which can make sex painful and less enjoyable.


• Key Herbs: Phytoestrogens, Good Fats, Tissue Toners, Mucilaginous Herbs &/or Libido Herbs. See “Moisture Support” for more details. Shatavari rocks!

• Sample Formula: • Shatavari 40% • Damiana or Maca 25% • Ashwagandha 24% • Cotton Root Bark 10% • Nutmeg or Ginger 1%

• Diet/Supplements: Eat fatty fish 2+x/week and/or take quality fish oil caps or flax oil (not flax pills) for good fats. Be sure to drink enough water or broth (bone or veg with some oil and a little salt or seaweed). Eat phytoestrogens: beans, flax seeds, maybe whole organic and/or fermented soy. Support digestion with bitters if fat digestion/assimilation is poor.

• Lifestyle: Foreplay and good lube! Cycle Irregularities: Heavy Flow: Erratic cycles, heavy bleeding, missed periods (which is normal during perimenopause since you may not ovulate every cycle), bad periods (w/o regular ovulation, the tissue builds up thick but not sophisticated and does not slough off easy when menstruation finally comes). • Key Herbs: Buffer estrogen, support progesterone. Encourage ovulation/oxytocin. Tissue toners.

Address anemia and heavy bleeds as needed with iron-rich herbs/food and astringents. • Sample Formula

• Vitex 30% • Partridge Berry 20% (if ecologically harvested, otherwise, YARFA teas) • Yellow Dock 20% • Cinnamon 20% • Black Cohosh 10% - debatable • Add Seprately: 1 ml Cotton Root Bark Tincture Days 12-14

• Tea Blend (nutrition & astringency) 1/2 oz steeped in 16 oz water overnight, drunk daily • Raspberry Leaf 30% • Nettle Leaf 30% • Lady’s Mantle Leaf/Flower 30% • Rose Petals 10%

• Diet/Supplements: Iron (Floradix liquid or Megafood Blood Builder pills) if needed. Red meat, marrow bone broths, strong nettle tea during heavy bleed times. Otherwise, limit meat and dairy. Phytoestrogens in the diet daily to buffer estrogen dominance: beans, ground flax seeds, maybe whole/organic/fermented soy.

• If weight and diabetes or blood sugar issues are involved, this should also be addressed long term with diet and herbs. Consider fenugreek.

Cycle Irregularities: Scanty Flow, Deficiency. We see this more often in the thin, andrenergic, cold woman. I see it often in nervous young women. They tend to have light periods, scanty flow, sometimes missed periods, often really bad cramps. May have long cycles. • Key Herbs: Estrogen support, possibly progesterone and oxytocin support. Emmenagogue and

herbs that increase blood flow and nutrition to the area. Adaptogens and relaxants may be useful. Also cramp support as needed. (See “Cramp Support.”)

• Sample Formula: • Dong Quai 40% (maybe also vitex, and day 12-14 cotton root bark)


• Codonopis or organic American Ginseng 25% • Holy Basil or Ashwagandha or Motherwort 20% • Ginger 10% • Licorice 5%

• Diet/Lifestyle: Tinker with diet to see if they do better on more of a Nourishing Traditions or Vegan style diet. Either way, make sure it’s a nutrient dense, warming diet, like soups. Stress?

Endometriosis, PCOS, Fibroids & Cysts: These are all complex and can be hard to treat, but there are some underlying similarities and approaches. • Key Herbs: Hormone balance (especially shatavari, black cohosh, vitex), anti-inflammatories,

antispasmodics, blood sugar regulation (if needed, ie: PCOS), liver support. • Sample Daily Formula:

• Black Cohosh 20% • Shatavari 20% • Fenugreek 20% • Dandelion Root or Artichoke Leaf 20% • Boswellia or Turmeric 15% • Ginger 5%

• Diet/Lifestyle: Avoid xenoestrogens in the diet/toxin exposure. In blood sugar-related issues, switch to a diet that supports this (Paleo, Mediterranean, low carb or slow burn high fiber carbs). Try avoiding these for 3-4 months to see if they aggravate: meat/dairy hormones, coffee/black tea/chocolate (xanthines). Boost B vitamins and magnesium to see if this helps. Try daily green tea and omega 3s from fatty fish, fish oil supplements, flax oil (not pills),which help decrease inflammation. Eating more beans and flax seed might help, too.

• As-Needed for Pain: cramp bark, wild yam, or angelica tincture. Ginger and/or cinnamon caps.

Quick Tips The following conditions can be caused or exacerbated by reproductive hormone wobbles. In addition to hormone support, here are some more targeted tips. Depression: Consider black cohosh and maybe vitex (watch to be sure vitex doesn’t make it worse) alongside St. John’s wort, mimosa bark (loving this one), and/or damiana. There have been some good studies on SJW plus black cohosh. Also feel free to work in uplifting adaptogens and nervines like milky oat seed, lemon balm, rhodiola, ashwagandha... Brain Fog: Consider rhodiola (zippy, personal fave) or if we need calm focus: gotu kola (slower acting), bacopa, holy basil, lemon balm. Mint and rosemary are also great and best if you can smell them (tea, in food, 5-15% synergists for tinctures). Also address sleep and nutrition (B vitamins, omegas...) if needed. Yeast Infections: Hormone wobbles (and birth control pills) can make us more prone to microbial imbalances, especially just before the period or in months where ovulation doesn’t occur. Alongside hormone balance support, boost probiotics and fermented foods, cut out sugar and white food, avoid excess carbs but enjoy high-fiber foods alongside adequate protein. Consider adding in antimicrobial herbs internally in tea, food, tincture: pau d’arco or desert willow, chaga, alder bark, bee balm or oregano or thyme, cinnamon, cloves, garlic. Cramps & Pain Support: See page 2 of these notes.

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