Women’s health conditions such as premenstrual syndrome (PMS), polycystic ovarian syndrome (PCOS), and heavy periods are common; 90% of cycling women experience PMS, 5-10% of cycling women in their childbearing years have PCOS, and 30% of cycling women have heavy periods. Additionally, every woman will go through the transition to menopause, which for some can be a difficult transition. Because of this, many women are turning to supplements to support their health; the Centers for Disease Control reported that in 2018, 63.8% of American women had taken a dietary supplement within the last 30 days. This article will discuss the top women’s health supplements and various functional medicine testing that can help decipher which supplement, if any, may be right for you.  

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Top Women’s Health Supplements Used By Integrative Medicine Practitioners

There are many supplements on the market for women's health; it can feel incredibly overwhelming to try and understand what supplement is appropriate for what symptoms and/or conditions. Let’s take a look at the top women’s health supplements and what they do.

Inositol

Inositols are compounds found in fruits, nuts, and grains, and our bodies also make them innately. Inositol and its various forms, including myo-inositol and d-chiro-inositol, have many benefits for women as they seem to positively affect ovarian functioning. Inositol is often recommended for women with PCOS, as there are ample amounts of research showing inositols improve the rates of ovulation, balance hormones, regulate menstrual cycles, improve hormonal acne, and also improve metabolic markers, which are often irregular in PCOS. There’s also research suggesting inositol’s effectiveness in regulating hormones in premenstrual dysphoric disorder (PMDD), a severe form of premenstrual syndrome (PMS), which may inhibit a woman’s quality of life.  

Dose: 100mg twice daily

Duration: 14 weeks

DHEA

DHEA is a hormone that is made by the adrenal glands. DHEA is considered an androgen as it can convert into testosterone. This conversion is significant for women, as 40-66% of testosterone production comes from DHEA. Most testosterone will then convert into estradiol, one of the most important hormones for women’s health. In addition to DHEAs implications on sex hormones, DHEA has also been deemed a “neurosteroid” since it can impact levels of neurotransmitters and neuron health. Because of these various actions, DHEA may be beneficial for fertility, increasing libido, and maintaining a healthy weight.

Dose: 25-200 mg daily, or the dose can be dependent upon testing levels.

Duration: Duration will be dependent upon symptom improvements and/or levels reaching reference ranges.

Omega 3 Fatty Acids

Omega 3 fatty acids are found in every single cell in our body. We cannot synthesize omega 3s and thus must retain them from our diet. Omega 3s can affect constriction and dilation of our blood vessels, clotting mechanisms in the blood, and, most pertinent to this article, regulating inflammation. Through modulating inflammatory pathways, omega-3 fatty acids were shown to reduce hot flashes, improve mood, and prevent cardiovascular sequela in perimenopausal women. For fertility, omega 3s impact on lowering inflammation was shown to improve egg quality. In women with PMDD, omega 3s were able to improve physical pain by adjusting inflammatory levels while also improving mood and lowering rates of depression and anxiety.

Dose: 2 g daily

Duration: 3 months

Chaste Tree Berry

Chaste tree berry is a botanical that has been used medicinally for over 2,500 years. Chaste tree berry has been shown to help increase levels of progesterone, the female hormone made only after ovulation, during the second half of the cycle. Additionally, chaste tree berries can help to lower prolactin levels; elevated prolactin can cause disruptions and problems in the menstrual cycle. These hormonal imbalances can be a root cause of heavy periods, premenstrual syndrome, and even gastrointestinal changes around menstruation. For PMS specifically, chaste tree berries can reduce symptoms by up to 50%. Additionally, evidence shows that chaste tree berry can also help lessen heavy periods.

Dose: 4 mg daily

Duration: Until symptoms subside and/or biomarkers stabilize

DIM

DIM is an extract found in cruciferous vegetables such as broccoli, cauliflower, and Brussels sprouts. DIM can be beneficial for estrogen detoxification, also called estrogen metabolism. Estrogen metabolism entails three phases. In the first phase, estrogen may go down one of three pathways. Two out of the three pathways may lead to the proliferation or growth of tissues; one pathway can increase the risk of breast cancer. DIM helps encourage estrogen to avoid these pathways and to instead utilize the third pathway, which some research shows can actually have a protective effect against breast cancer. Additionally, because DIM helps phase one of estrogen metabolism, it may also be beneficial in cases of estrogen excess as it helps estrogen to leave the body. Excess estrogen, or estrogen dominance, has been associated with heavy and painful periods, irregular cycles, fibrocystic breasts, acne, insomnia, weight gain, PMDD, and PMS.

Dose: 100-200 mg per day

Duration: 1-12 months

Vitamin D

Vitamin D helps to modulate immune and inflammatory pathways, bone mineralization, muscles, and blood sugar. Additionally, vitamin D may be beneficial for hormone health as it seems to affect how the ovaries work, including how the ovaries produce progesterone and the body’s sensitivity to hormones. Vitamin D deficiencies have been correlated to women’s hormone conditions, including PCOS, ovarian cysts, and menopause. Vitamin D may be especially important for menopausal women for its actions on hormones and on bone mineralization, as bone mineralization decreases with menopause.

Dose: Vitamin D dosage should be dependent upon laboratory values.

Duration: Duration of supplementation will depend on values achieving reference range and the alleviation of symptoms.

Zinc

Zinc is a mineral involved in many processes in the body, including growth and development, immune, neurological, gastrointestinal, and reproductive functioning. Zinc is required for the proper function of sex hormone receptors. Receptors and hormones work like locks and keys; the hormone must bind to the receptor in order to induce action in the body. Thus, receptor functioning is arguably as important as the hormone itself! Zinc also plays a role in the release of hormones, specifically testosterone. Because of these actions, zinc can be beneficial for painful periods, PMS, hormonal acne, and low libido.

Dose: 220 mg daily

Duration: 24 weeks

Calcium-d-glucarate

When dysbiosis is present with the estrobolome in the microbiome, estrogen recycling will occur rather than estrogen disposal. Calcium-d-glucarate is a type of calcium that is able to inhibit beta-glucuronidase, the enzyme released by the microbes in the estrobolome that causes estrogen to be recycled into the bloodstream. Thus, calcium-d-glucarate can help with estrogen metabolism and help lower estrogen levels. This mechanism, in turn, can help with PMS, hormonal acne, PCOS, infertility, heavy periods, thyroid disorders, and menstrual cycle irregularities.

Dose: 1,500-3,000 mg daily

Duration: Until symptoms subside and/or beta-glucuronidase levels normalized on stool testing.

Probiotics

Probiotics are supplements that contain strains of various beneficial microbes naturally found in the gut microbiome. The estrobolome, microbes that aid in estrogen metabolism, is a part of the gut microbiome, and thus, a healthy microbiome is vital for hormone balance. Additionally, there is evidence that probiotics can be beneficial in the treatment of many women’s health conditions, including fertility and PMS.

Dose: The dose of probiotics can be determined using comprehensive stool testing.

Duration: The duration of probiotics should be determined by symptom improvement and improvement of lab markers.

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Functional Medicine Labs to Test for Root Cause of Women’s Health Conditions

The functional medicine testing catalog for women’s health is vast. Let’s take a look at some of the top labs for women’s health conditions:

DUTCH Testing

The DUTCH test by Precision Analytical is a dried urine test that analyzes metabolites of sex hormones in the urine. By assessing these metabolites, we can extrapolate how the body is breaking hormones down or metabolizing them. Knowing both the levels of hormones, which the DUTCH test also provides, and seeing how the hormones break down gives the practitioner and patient a surplus of information that can help to identify the problem behind their condition and/or symptoms. Hormones included in the DUTCH test are estradiol, estrone, progesterone, testosterone, DHEA, and their metabolites. Additionally, the DUTCH test has a stress and adrenal section that evaluates the active and inactive form of cortisol, our primary stress hormone and daytime circadian rhythm hormone, throughout the day. Stress has a significant influence on sex hormone levels, and thus, having a test that evaluates both stress and sex hormones can be a powerful tool.

Blood Hormone Testing

While some hormones can be checked in the urine, like the hormones listed above, there are certain hormones that are more appropriately checked in the blood due to the size of the hormone. These hormones include follicle-stimulating hormone (FSH) and luteinizing hormone (LH) and can be found together on one panel, such as the FSH & LH test by Access Medical Laboratories. Both of these hormones are produced by the pituitary gland in the brain and orchestrate the cycle; essentially, they instruct the ovary to perform certain functions, such as producing hormones and releasing the egg, during specific times in the cycle. Thus, FSH and LH levels will fluctuate throughout the cycle. However, abnormal levels of these hormones are common in conditions like PCOS, and these hormones can also help to identify if a woman is approaching menopause.

Another important hormone to be checked in the blood is prolactin, such as the Prolactin test by Boston Heart Diagnostics. Prolactin is a hormone that should only be high in women who are breastfeeding, as it induces milk production in the breasts. High prolactin can lead to imbalances in estradiol and progesterone levels. High prolactin outside of breastfeeding is always abnormal and should be further evaluated.

Additionally, a thyroid panel, such as the Thyroid Panel by Access Medical Laboratories, may also be helpful. A thyroid hormone panel will consist of TSH, T4, and T3. Both hypothyroidism, where the thyroid gland does not make enough of these hormones, and hyperthyroidism, where the thyroid gland produces too much, can lead to sex hormone imbalances.

Comprehensive Stool Test

Comprehensive stool tests evaluate markers of inflammation, digestion, absorption, and immune activation within the gastrointestinal tract. Most pertinent to this discussion, comprehensive stool tests also have a marker for estrogen metabolism and give insight into the gut microbiome. Estrogen metabolism occurs in three steps: the first two steps are in the liver, and the last step is in the gut. In the gut, microbes within the microbiome are responsible for packaging the last remnant of estrogen to be put into the stool for excretion; these microbes are referred to as the “estrobolome.” However, when there is dysbiosis or an imbalance in good and bad microbes in the estrobolome, this process does not go as planned, and the estrobolome releases an enzyme called beta-glucuronidase. This enzyme causes estrogen to be recycled and sent back into the bloodstream. This, in turn, can lead to high estrogen levels and hormone imbalances. Comprehensive stool tests, such as GI360 by Doctors Data, will measure levels of beta-glucuronidase and give an analysis of the microbiome as a whole, showing if there is dysbiosis present and helping to address what can be done to fix it.

Micronutrient Testing

Micronutrient testing involves assessing levels of many micronutrients, including vitamins, minerals, and fatty acids, on one convenient test. Since many micronutrients are involved in hormone physiology, including zinc, vitamins A, D, B6, and omega 3 fatty acids, micronutrient testing, such as the Spectracell Micronutrient Panel, is warranted and can help to treat various hormonal disorders.

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Summary

Women’s health conditions are common, especially during childbearing years, when hormones fluctuate on a monthly cycle. Many supplements may help to alleviate symptoms through various mechanisms. Some supplements may help in raising progesterone levels while others help with estrogen detoxification; others may help with hormone receptor sensitivity and some can aid in lowering inflammation. Figuring out which supplement is right for you may be confusing, but that's where functional medicine testing can help. Results from testing can guide the practitioner and patient to both the appropriate supplement and dose to resolve symptoms and improve their quality of life.