Perimenopause as a Hidden Trigger of Migraines

It is well-established that migraine attacks can be triggered by hormone changes. If you’re navigating perimenopause and notice an increase in headache intensity or frequency – you’re not alone. Some women find that migraines worsen during this life phase, while some experience migraines for the first time as their hormone levels shift. While many women with migraines are diagnosed in their teens or 20s, roughly 8 to 13% don’t get diagnosed until they are in perimenopause because their symptoms – including headaches, nausea, and fatigue – become much more intense[i]

Hormones and Migraines: The Connection

It is not clearly known why hormonal shifts can cause an increase in migraines. Some research suggests that changes in estrogen levels make certain cells more excitable – which may make you more sensitive to migraine triggers[ii]. Estrogen doesn’t just impact reproductive health; it plays a vital role in managing pain by controlling key brain neurotransmitters. When levels drop, the brain becomes more susceptible to pain signals, which can make migraines feel more intense and frequent. Fluctuating estrogen can also increase a person’s mast cells – a type of immune cell that triggers inflammation in the brain and often increases headache pain.

Why Estrogen Dominance Matters

Most research is on the effect of low estrogen in menopause (defined as not having a menstrual bleed for a year), but clinically I find that women in perimenopause can be affected even more frequently due to estrogen dominance.

Estrogen dominance happens when estrogen levels are high compared to progesterone. In perimenopause, a decrease in progesterone levels is the most common hormonal shift, usually happening in late 30s or early 40s. This can lead to symptoms like heavier menstrual bleeding, anxiety, and insomnia. But remember – the estrogen levels have not increased, but there is an imbalance.

Your liver also plays a role here. Women are often not metabolizing and eliminating their estrogen efficiently through their liver pathways, which can lead to additional challenges with weight gain, irritability, body pain, and of course, more frequent migraines.

Testing Your Hormone Levels

The symptoms of hormonal imbalance can be very clear, but there is a valuable and objective tool we recommend: the DUTCH Test. Unlike a standard blood test, this advanced 24-hour urine test measures estrogen and progesterone levels over a full day and evaluates how well your liver is metabolizing estrogen. With the DUTCH Test, we can get an in-depth look at your hormonal landscape, helping us create a tailored approach to bring your body back to balance.

Relief is Possible

The good news? Estrogen dominance and its symptoms can be addressed with strategic diet and lifestyle changes and targeted supplementation. Nutrients from cruciferous vegetables (broccoli, cauliflower, brussels sprouts, cabbage, etc.) can support liver health and help balance estrogen levels. Pairing these with dietary tweaks can make a big difference in reducing migraine frequency and severity.

Once you have identified your hormonal imbalance and have a plan, women usually experience improvements within a few weeks. Migraines can significantly affect your quality of life, but with the right support, relief is within reach.

Yours in good health,

Dr. Darlene Reid, ND

[i] Pavlović JM. The impact of midlife on migraine in women: summary of current views. Womens Midlife Health. 2020 Oct 6;6:11. doi: 10.1186/s40695-020-00059-8. PMID: 33042563; PMCID: PMC7542111.

[ii] Reddy N, Desai MN, Schoenbrunner A, Schneeberger S, Janis JE. The complex relationship between estrogen and migraines: a scoping review. Syst Rev. 2021 Mar 10;10(1):72. doi: 10.1186/s13643-021-01618-4. PMID: 33691790; PMCID: PMC7948327.

Love the Skin You're In

Your skin is the largest organ in your body. It protects and gives you signals from the environment, and regulates temperature and water. We often don’t think about the functions of our skin until it starts to cause us problems – itching, rashes, acne, discoloration, premature aging, etc – all of which can be a signal of something deeper going on in our body. The skin is also a great absorptive surface, for better or for worse. We can use this effect to our benefit for absorbing certain medications or nutrients applied topically (eg. estrogen, testosterone, magnesium), though the absorptive nature of skin also makes us susceptible to adverse effects from environmental exposures that may be allergic or irritant in nature.

ouTSIDE IN VS AND INSIDE OUT

Whether it’s limiting exposures to harmful substances, or increasing exposure to therapeutic agents, both internal and external approaches can, and should, be used in conjunction to promote optimal skin health.

outside in

Skin & The Immune System —> Allergies

An allergic response occurs when the immune system reacts abnormally to a substance found in the environment. The substance that provokes the reaction is called an allergen.

3 Categories of Allergens:

• Ingested allergens - reactions to food or things consumed orally

• Inhaled allergens - reactions to substances we breathe in

• Contact allergens - reactions to substances applied on skin or mucus membranes (lips, mouth, groin)

Skin Allergies

1. Allergic reactions tend to happen after repeated exposure to a substance. The reaction never happens to the first exposure because the immune system must first become sensitized to the chemical.

2. Once you have been sensitizes, you will always be allergic to it.

3. Sudden development of allergies is possible.

4. Even small amounts of allergen can trigger a reaction that can last for several weeks.

5. With each new exposure, the reaction becomes stronger.

6. The reaction can spread beyond the exposure site.

7. A reaction need not happen immediately - it can take hours or days to present.

Allergy Testing

• Prick testing - for allergens ingested or inhaled

• Patch testing - for contact allergens

Top Allergens in Personal Care Products

1. Fragrances

2. Preservatives

3. Hair dyes

4. Lanolin

5. Synthetic detergents

6. Botanicals

7. Nail cosmetics

8. Sunscreens

Skin and The Immune System —> Irritants & Intolerances

Skin irritants elicit non-allergy reactions, that may be immediate, dose-dependent, and/or cumulative.

Irritant Reactions

• Irritation is dose-dependent - the more you are exposed, the more severe the reaction.

• Irritation is cumulative - multiple exposures, multiple chemicals.

• Irritation can happen after a single exposure.

• Irritation does not necessarily happen after every exposure (cumulative exposures impact the outcome).

• An irritant reaction can happen immediately after exposures and can resolve quickly after exposure ends.

Top Irritants in Personal Care Products

1. Water

2. Soap and detergents

3. Fragrances

4. Botanicals

5. Alcohol

6. Abrasive scrubs

7. Vitamin A derivatives and Alpha-Hydroxy Acid (AHA)

8. Shampoos and conditioners

inside out

Your skin is also reflective of what is going on within your body. We see this often with certain conditions that have dermatologic manifestations, such as Celiac disease (dermatitis herpetiformis), systemic lupus erythematosus (malar erythema), PCOS (acne) and many others. Aside from diagnosable pathologies, functional imbalances and other factors can also impact the quality and health of our skin. These may include:

• Inflammation

• Hormonal imbalances

• Diet

• Digestive issues

• Food sensitivities

• Sun exposure

• Stress

• Nutrient deficiencies

• Immune dysfunction

• Medications or supplements

• Smoking

• Infections

Skin problems are often multifactorial, and as such often require a multi-factorial approach. Whether you are addressing the symptoms of chronic disease or looking to improve the appearance and health of your skin overall, optimizing and correcting any one or several of these factors may be necessary to achieve desired results.

THE FIRST STEP TO TREATMENT IS A PROPER ASSESSMENT.

Deciding where to start can be overwhelming. With no shortage of information online, many times patients are confronted with information and option overload. A detailed history taking with a health professional can help to narrow down areas to focus on and get you started on a treatment plan tailored to your individual needs to help you love the skin you’re in.

In health,

Dr. Jacalyn Sieben, ND

PS - for more information about a holistic Outside-In approach I highly recommend the book referenced below.

Reference:

Skotnicki, S. (2018). Beyond soap: The real truth about what you are doing to your skin and how to fix it for a beautiful, healthy glow. Penguin Random House.

Your Health, Your Comfort: Embracing a Scent-Free Environment

We talk a lot about keeping our clinic a scent-free space, but we thought it would be important to explain the reason WHY. You may be thinking, “I don’t wear perfume”, but you may be surprised to know that scents can be following you around through the detergent or fabric softener you use, the shampoo you wash your hair with, or the cleaning products you just used to clean your home and have stuck onto your clothes. In fact, these substances can be found in thousands of consumer and industrial products - and they may be wreaking havoc on your body.

A growing number of scented products are available on store shelves, and our homes are becoming more and more saturated with airborne chemicals. It’s almost impossible to avoid exposure to these substances, and they are contributing to poor indoor air quality all around the world. While Canadians spend approximately 90% of their time indoors [i], the concentrations of some pollutants are often 2 to 5 times higher than typical outdoor concentrations [ii] [iii]. Usually this boils down to a lack of ventilation. In addition to scents and fragrances from various products we use indoors, when outdoor pollutants make their way indoors (tracked in on shoes, residue on clothing, etc.), they end up concentrating in higher amounts than they would outside (because there is less airspace for them to occupy inside). [iv] All of this adds to the challenges of keeping your indoor air clean.

Let’s look at one of the biggest offenders: Phthalates.

What are phthalates? Phthalates are the reason why your deodorant keeps you smelling fresh on hot summer days. They are why a new diaper has that powdery-soft baby smell. Or why your sheets still smell clean even after sleeping in them for a day or two. Phthalates are used to make fragrances last longer.

But it doesn’t stop there. Fake Christmas trees have phthalates. Vinyl flooring contains phthalates. Rubber duckies contain phthalates. Phthalates can even be found in food products. This is a reason why phthalates are called the “Everywhere Chemical”.

A single product may contain up to 300 different fragrance ingredients, but there are over 3000 different chemicals a manufacturer can choose from – even ones that are known irritants, allergens, and carcinogens. Health Canada says that most phthalates don’t pose a risk to health, and therefore phthalates will not appear on ingredient labels; instead, they are grouped in as “fragrance” or “perfume/parfum.”[v]

After tobacco smoke, perfumes are one of the most noticeable air contaminants in public places and the workplace. They are reported to cause difficulties for most people with environmental sensitivities.[vi] A 2009 study that appeared in the Journal of Environmental Health showed that around 30% of the general population found other people wearing fragrances to be irritating.[vii] “Irritating” doesn’t mean that someone is merely bothered by it – we are talking nausea, migraines, difficulty breathing, rashes, stuffy or runny noses…the list goes on. For people who have asthma, the study found that 37% of people were aggravated by scented products.

Further, there is growing evidence that shows the link between these chemicals and a long list of health conditions. We’re talking changes to fertility, hormonal imbalance, inflammation, excess weight, sleep disturbances, elevated stress levels, issues with childhood growth and development…this list also goes on.

When we ask for your help to make Saskatoon Naturopathic Medicine a scent-free space, it’s so we can make our clinic a safe and comfortable place for all patients who visit. As your trusted experts in natural health care, it is our job to share our knowledge to help you make better choices for yourself and those around you. If you are interested in learning more, our NDs would love to chat with you!

[i] https://www.canada.ca/en/environment-climate-change/campaigns/canadian-environment-week/clean-air-day/indoor-quality.html          

[ii] https://www.epa.gov/report-environment/indoor-air-quality#note2    

[iii] https://www.epa.gov/indoor-air-quality-iaq/inside-story-guide-indoor-air-quality             

[iv] https://www.airqualitycanada.ca/news/indoor-and-outdoor-air-pollution          

[v] https://www.canada.ca/en/health-canada/services/chemicals-product-safety/phthalates.html

[vi] https://www.chrc-ccdp.gc.ca/sites/default/files/envsensitivity_en.pdf

[vii] https://pubmed.ncbi.nlm.nih.gov/19326669/

STRESS AND THE HORMONE CONNECTION

Stress is one of the top concerns for which patients seek medical support. Stress is a hormonal response of the body when we perceive we are under threat. The “fight or flight” response is a sympathetic nervous system response which is engaged when we encounter a stressful event, such as running into a predator. This response allows our bodies to fight or flee, protecting ourselves from danger. Once the danger has passed, our bodies shift to a relaxation state, or an activation of the parasympathetic nervous system.

Today, it is common to see chronic stress - stressful events or situations that do not pass, which results in our sympathetic nervous system being active for much longer than it is meant to be. Having chronic stress responses can lead to a variety of changes in our body, including changes in blood pressure, blood sugar, digestive issues, and hormonal imbalances.

Cortisol

Cortisol is one of the main hormones released by our adrenal glands (which sit atop the kidneys) during periods of stress. Normally, cortisol is released in a diurnal pattern - this means they rise and fall in a similar pattern throughout a 24 hour period. This is called our circadian rhythm. Typically, cortisol should be at its highest in the morning right after we wake up, and will drop throughout the day until it reaches its lowest levels in the evening around bedtime. Throughout the night, they will slowly begin to increase again until waking time the next day, and so on. In this normal pattern, cortisol functions in regulating the immune system, managing inflammation, and regulating our blood sugar and metabolism. However, during periods of increased stress, more cortisol is released into our bloodstream, which can impact our circadian rhythm and lead to health consequences - such as changes in appetite and weight, blood sugar imbalances, high blood pressure, memory impairment, and interference with other hormones such as melatonin, estrogen and testosterone.

How can I measure my cortisol levels?

Cortisol levels can be measured in the blood through regular blood work - keep in mind that because of cortisol’s diurnal rhythms, cortisol levels will change throughout the day and will be different depending on the time the blood draw is done. Also, cortisol may increase if you are nervous about getting a needle. Alternative ways to measure cortisol include through saliva and urine, which can be easily done at home multiple times throughout the day to provide a “4-point” measurement of cortisol (measured at four points throughout the day to make a graph of your diurnal rhythm).

Your naturopathic doctor has access to all of these types of testing, and can requisition a test for you to assess your cortisol levels. There are urine testing options, specifically Rocky Mountain Analytical’s Comprehensive Hormone Insights (CHI) test and Precision Analytical’s DUTCH test, both of which offer cortisol testing at multiple points throughout the day as well as an extensive assessment of hormonal health, including levels of estrogens, androgens and progesterone and their metabolites. These tests allow for an assessment of your hormone levels and an analysis of the interplay between them!

Based on the results of your test, your naturopathic doctor will recommend a holistic plan for you to support your hormones and decrease the impact stress has on your body and health. There are lots of modalities that have been found to help manage stress and reduce cortisol levels, including nutritional supplements, dietary changes, lifestyle recommendations, and even traditional medicine such as acupuncture and homeopathy.

Keep in mind that cortisol levels can be altered for medical reasons other than stress, and these conditions would be approached and treated differently!

Have questions about stress and cortisol testing? Call us today to get more information and to set up an appointment with one of our naturopathic doctors!

References:

https://www.ncbi.nlm.nih.gov/books/NBK538239/

HAPPY HORMONES - A NATUROPATHIC APPROACH

Hormones direct many different systems in your body. They are involved in stress management, thyroid function, glucose regulation, and reproductive health.  

Join naturopathic doctors Dr. Darlene Reid-Ahenakew and Dr. Amy Velichka on Monday, May 14th for an integrative perspective on hormonal health. This presentation will begin at 7 pm at McNally Robinson Bookstore on 8th Street in the travel alcove. 

Learn ways to promote a healthy hormonal balance to improve the way you look, feel and age. There is no cost to attend. Come on out and bring a friend!

MYERS COCKTAIL

What is a Myers Cocktail?

One of the most common IVs provided by naturopathic doctors across North America is a Myers cocktail. 

What is in this popular IV and what can it be helpful for? 

The Myers cocktail is an intravenous mixture of minerals and vitamins that is administered directly into a vein and is infused over a timespan of 30-45 minutes. It can be effective against asthma symptoms, migraines, fatigue, fibromyalgia, acute muscle spasm, upper respiratory tract infections, chronic sinusitis, seasonal allergic rhinitis, and cardiovascular disease. 

The vitamins in the Myers cocktail include vitamin C, vitamin B complex, vitamin B12, magnesium, and calcium. It is a fairly simple formula. However, taking these nutrients intravenously means they are 100% absorbed into circulation which is dramatically more than the absorption through the gut with oral supplementation. Though the high levels of nutrients provided by a Myers cocktail will only last a few hours in circulation, the benefits can be profound over the long-term. 

Some patients may receive the Myers cocktail weekly or monthly. Naturopathic doctors may recommend this option when a patient has trouble with absorption (including patients with IBS or IBD) or when a patient is chronically ill and a less invasive nutritional plan is not effective.  Naturopathic doctors work with their patients with complex health conditions to identify root cause issues and assess an individuals need for advanced nutritional IV therapy.  Patients who are a candidate for this treatment will be assessed by their naturopathic doctor to ensure safety and to consider any individual modifications to the formula that may be required. 

To learn more about the effectiveness of the Myers cocktail including its history, applications, theory, and research please read the following review by Dr. Alan Gaby, MD —> Intravenous Nutrient Therapy: The “Myer’s” Cocktail.

To find out more if this or other nutrient IVs might be appropriate for you, contact our office to book an IV therapy consult with your naturopathic doctor!