Tag: hormone balance

Bioidentical Hormones and Heart Health: The Role of Estrogen, Testosterone, and Thyroid in Cardiovascular Function

by Roxy Functional Wellness, posted in Hormone Health

Hormones play a critical role in cardiovascular health, influencing blood pressure, cholesterol levels, arterial flexibility, and inflammation. As we age, natural hormone fluctuations—especially in estrogen, testosterone, and thyroid hormones—can significantly impact heart function and metabolic health.

The functional medicine approach focuses on balancing hormones naturally through lifestyle modifications, targeted supplementation, and bioidentical hormone replacement therapy (BHRT) when needed. In this blog, we’ll explore how hormonal imbalances contribute to heart disease, the benefits of bioidentical hormone replacement, and natural strategies to optimize hormonal health for a stronger heart.

The Connection Between Hormones and Heart Health

Hormones regulate key cardiovascular functions, including blood vessel dilation, cholesterol metabolism, and blood sugar control. When hormone levels become imbalanced, they can contribute to hypertension, atherosclerosis, and metabolic dysfunction (American Heart Association [AHA], 2023).

Here’s how three key hormones—estrogen, testosterone, and thyroid hormones—affect the heart:

1. Estrogen and Cardiovascular Protection

Estrogen plays a protective role in heart health by:

  • Improving arterial flexibility and blood flow.
  • Regulating cholesterol levels by increasing HDL and reducing LDL.
  • Reducing inflammation and oxidative stress.

Estrogen Decline and Increased Heart Risk

  • During menopause, estrogen levels plummet, leading to higher blood pressure, increased cholesterol, and arterial stiffness.
  • Studies show that postmenopausal women have a higher risk of heart disease compared to premenopausal women (Muka et al., 2022).
  • Estrogen deficiency increases the risk of metabolic syndrome, insulin resistance, and type 2 diabetes, all of which raise cardiovascular risk.

Bioidentical estrogen therapy (estradiol or estriol) may:

  • Reduce arterial stiffness and improve circulation.
  • Help maintain healthy cholesterol levels.
  • Lower C-reactive protein (CRP) levels, a marker of inflammation linked to heart disease.

Functional Medicine Approach:

  • Consider bioidentical hormone replacement therapy (BHRT) with personalized estrogen dosing.
  • Consume phytoestrogen-rich foods (flaxseeds, soy, lentils) to support estrogen balance.
  • Support liver detoxification (cruciferous vegetables, dandelion tea) to ensure healthy estrogen metabolism.
2. Testosterone and Cardiovascular Function

Testosterone is often thought of as a male hormone, but it plays a critical role in both men’s and women’s heart health.

How Testosterone Supports Heart Health

  • Increases nitric oxide production, promoting arterial relaxation and healthy blood pressure.
  • Supports muscle mass and metabolism, reducing obesity-related heart risks.
  • Reduces insulin resistance, lowering the risk of type 2 diabetes and metabolic syndrome.

Low Testosterone and Cardiovascular Risks

  • Men with low testosterone levels have an increased risk of heart attacks, strokes, and hypertension (Yeap et al., 2021).
  • Low testosterone in women can contribute to fatigue, poor circulation, and higher inflammation levels.
  • Studies suggest testosterone therapy in men with deficiency may reduce heart disease risk (Traish et al., 2022).

Testosterone Optimization Strategies

  • Testosterone Replacement Therapy (TRT) may be beneficial for those with clinically low levels.
  • Weight training and resistance exercises naturally boost testosterone.
  • Consume healthy fats (avocados, olive oil, nuts) to support testosterone production.
3. Thyroid Hormones and Heart Rate Regulation

The thyroid gland produces T3 (triiodothyronine) and T4 (thyroxine), which regulate metabolism, heart rate, and blood vessel function.

Thyroid Dysfunction and Heart Health Risks

⚠ Hypothyroidism (low thyroid function):

  • Slows metabolism, leading to weight gain and higher cholesterol levels.
  • Can cause bradycardia (slow heart rate) and increased risk of atherosclerosis.
  • Associated with higher blood pressure and arterial stiffness.

⚠ Hyperthyroidism (overactive thyroid):

  • Increases heart rate (tachycardia) and risk of arrhythmias.
  • Elevates stroke risk due to atrial fibrillation.

Bioidentical Thyroid Support and Functional Strategies

  • Natural desiccated thyroid (NDT) or bioidentical T3/T4 therapy can restore optimal levels.
  • Consume iodine-rich foods (seaweed, fish, eggs) to support thyroid hormone production.
  • Reduce stress (chronic cortisol elevations impair thyroid function).
  • Check for nutrient deficiencies (selenium, zinc, vitamin D) that affect thyroid hormone conversion.

The Functional Medicine Approach to Hormonal Balance and Heart Health

Rather than treating symptoms alone, functional medicine focuses on optimizing hormone levels naturally to prevent cardiovascular disease.

1. Comprehensive Hormone Testing
  • Saliva, blood, or urine tests to assess estradiol, progesterone, testosterone, TSH, free T3, free T4, and cortisol levels.
  • Advanced cholesterol and inflammation testing (LDL particle size, hs-CRP) to evaluate cardiovascular risk.
2. Personalized Bioidentical Hormone Replacement Therapy (BHRT)
  • Estradiol and estriol therapy for menopausal women.
  • Testosterone therapy for men with clinically low levels.
  • Natural desiccated thyroid or compounded T3/T4 for hypothyroidism.
3. Nutritional and Lifestyle Strategies for Hormonal & Heart Health
  • Healthy Fats: Avocados, nuts, coconut oil, and olive oil support hormone synthesis.
  • Protein-Rich Diet: Grass-fed meats, fish, and legumes provide essential amino acids.
  • Adaptogenic Herbs: Maca, ashwagandha, and rhodiola balance stress hormones.
  • Regular Exercise: Improves insulin sensitivity, boosts testosterone, and reduces estrogen dominance.

Bringing it together

Hormonal balance plays a critical role in cardiovascular health. Estrogen, testosterone, and thyroid hormones regulate blood pressure, cholesterol, metabolic function, and arterial health. A functional medicine approach ensures optimal hormone balance through:

✅ Comprehensive hormone testing

✅ Personalized BHRT when needed

✅ Nutrition and lifestyle interventions

By addressing hormonal imbalances, we can reduce cardiovascular risk, improve energy levels, and support long-term heart health.

Written By: Roxanne Oliver, DNP, APRN, FNP-BC, CHHP

*The information contained in this post is for information only. It does not replace routine follow-up and/or care with a certified and licensed medical provider

References

American Heart Association. (2023). Hormones and heart disease risk. Retrieved from https://www.heart.org

Muka, T., Oliver-Williams, C., Kunutsor, S., et al. (2022). Association of postmenopausal hormone therapy with cardiovascular disease: A meta-analysis. JAMA Cardiology, 7(4), 383-392.

Traish, A. M., Haider, K. S., & Haider, A. (2022). Testosterone therapy and cardiovascular health: A review. American Journal of Men’s Health, 16(2), 15579883221100377.

Yeap, B. B., Alfonso, H., Chubb, S. A., et al. (2021). Low testosterone levels predict increased risk of cardiovascular events. The Journal of Clinical Endocrinology & Metabolism, 106(5), 1306-1314.

Decoding Your Morning Routine: Functional Habits That Balance Hormones All Day

by Roxy Functional Wellness, posted in Health & Wellness

In the world of functional medicine, we know that small habits create big shifts.
Your morning routine isn’t just about productivity—it’s about setting the biochemical tone for your hormones, energy, metabolism, and even mood throughout the day.

If you often feel wired but tired, experience energy crashes, cravings, or mood swings, chances are your morning routine needs some fine-tuning. Let’s decode the key functional habits that can create hormone harmony from the moment you wake up.

1. Get Natural Sunlight Exposure Within the First Hour

Why it matters:
Morning sunlight exposure helps regulate your circadian rhythm, cortisol awakening response, and melatonin production later in the evening.
A consistent light-dark cycle is crucial for balanced cortisol, thyroid function, and reproductive hormones.

Simple Tip:

  • Step outside for 5–10 minutes within 30–60 minutes of waking—even on cloudy days.
  • No sunglasses, no glass windows—natural light directly into your eyes and onto your skin is ideal.

Bonus: Early sunlight also boosts dopamine levels, helping you feel more motivated and focused.

2. Prioritize Proper Hydration (Before Coffee)

Why it matters:
After 6–8 hours without water, your body is naturally dehydrated, which can concentrate cortisol, slow digestion, and strain adrenal and thyroid function.

Simple Tip:

  • Start your morning with a glass of filtered water—ideally with a pinch of sea salt or trace minerals to replenish electrolytes.
  • Add a squeeze of lemon for additional liver and digestive support.

Hydration before caffeine ensures you’re not further stressing the adrenal glands or spiking cortisol unnaturally.

3. Eat a Protein-Rich Breakfast

Why it matters:
Skipping breakfast or eating a carb-heavy meal first thing (like pastries, cereal, or toast) can lead to a blood sugar spike—and crash.
Balanced blood sugar = balanced cortisol, insulin, and sex hormones.

Simple Tip:

  • Aim for 25–30 grams of protein at breakfast (think pasture-raised eggs, turkey sausage, a protein smoothie, or Greek yogurt with seeds).
  • Pair with healthy fats (avocado, nuts, olive oil) and fiber for even better blood sugar control.

Protein first helps stabilize appetite, mood, and energy for hours to come.

4. Start With Mindfulness, Not Your Phone

Why it matters:
The first few minutes after waking set your brainwave patterns for the day. Scrolling social media, emails, or news creates a stress response, activating the sympathetic (“fight or flight”) nervous system.
This hijacks your cortisol curve and leaves you feeling overwhelmed before you even start your day.

Simple Tip:

  • Take 2–5 minutes to breathe deeply, pray, meditate, or simply stretch before touching any electronics.
  • Gratitude journaling or setting a daily intention are powerful, hormone-friendly practices too.

How These Habits Work Together

When you align your morning with your body’s natural rhythms, you:

  • Support a healthy cortisol awakening response
  • Stabilize blood sugar and insulin
  • Reduce inflammation
  • Balance thyroid, adrenal, and sex hormones
  • Enhance mood, focus, and energy naturally

Functional medicine isn’t about adding complicated rituals—it’s about mastering the foundational rhythms that your body is already designed to follow.

Final Thoughts

You don’t have to overhaul your life overnight.
Start with one habit tomorrow morning: step outside, drink mineralized water, eat a high-protein breakfast, or put your phone away for the first 10 minutes.
Over time, these simple changes compound into major shifts in your energy, metabolism, and hormone health.

Because in functional medicine, we believe that the first hour of your day… shapes the next 23.

Written By: Roxanne Oliver, DNP, APRN, FNP-BC, CHHP

*The information contained in this post is for information only. It does not replace routine follow-up and/or care with a certified and licensed medical provider

References

Bass, J., & Lazar, M. A. (2016). Circadian time signatures of fitness and disease. Science, 354(6315), 994-999. https://doi.org/10.1126/science.aah4965

Czeisler, C. A., & Gooley, J. J. (2007). Sleep and circadian rhythms in humans. Cold Spring Harbor Symposia on Quantitative Biology, 72, 579–597. https://doi.org/10.1101/sqb.2007.72.064

Farhud, D. D., & Aryan, Z. (2018). Circadian rhythm, lifestyle and health: A narrative review. Iranian Journal of Public Health, 47(8), 1068–1076. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6125010/

O’Connor, S. G., Koziel, J., He, K., & Anderson, G. (2022). Breakfast macronutrient composition influences postprandial glycemia, appetite, and energy intake in overweight and obese adults: A randomized controlled trial. Nutrients, 14(3), 637. https://doi.org/10.3390/nu14030637

Romijn, J. A., Cani, P. D., & Blaak, E. E. (2021). The role of the gut–brain axis in energy and glucose metabolism. Endocrinology and Metabolism Clinics of North America, 50(3), 587–602. https://doi.org/10.1016/j.ecl.2021.05.005

Walker, M. P. (2017). Why we sleep: Unlocking the power of sleep and dreams. Scribner.

Zhou, J., Zhang, Y., Tang, L., & Xu, F. (2019). Mindfulness and hormone regulation: Theoretical framework and review. Frontiers in Psychology, 10, 799. https://doi.org/10.3389/fpsyg.2019.00799

Whelton, P. K., Carey, R. M., Aronow, W. S., et al. (2018). 2017 ACC/AHA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults. Journal of the American College of Cardiology, 71(19), e127–e248. https://doi.org/10.1016/j.jacc.2017.11.006
(Referenced for hydration’s importance in blood pressure and metabolic balance.)

Hidden Toxins and Your Heart: How Environmental Exposure Affects Cardiovascular Health

by Roxy Functional Wellness, posted in Cardiovascular Health

The American Heart Association (AHA, 2023) and the World Health Organization (WHO, 2022) recognize that environmental toxins contribute to high blood pressure, inflammation, and arterial damage. Below are some of the primary toxic threats to cardiovascular wellness:

1. Heavy Metals: Lead, Mercury, and Cadmium

Exposure to heavy metals—commonly found in contaminated water, industrial pollution, and certain foods—has been strongly linked to hypertension, arterial plaque buildup, and oxidative stress (Vaziri, 2022).

  • Lead: Found in old plumbing, paint, and soil, lead exposure increases blood pressure and disrupts calcium metabolism, harming blood vessels.
  • Mercury: Present in certain fish (e.g., tuna, swordfish), mercury increases oxidative stress and inflammation, raising the risk of heart disease.
  • Cadmium: A toxin found in cigarette smoke and industrial pollution, cadmium is associated with atherosclerosis and endothelial dysfunction.

Functional Medicine Solution:
✅ Test for heavy metals via hair, urine, or blood analysis.
✅ Consume cilantro, chlorella, and fiber-rich foods to bind and remove heavy metals.
✅ Filter drinking water to eliminate lead and other contaminants.

Photo by Pixabay on Pexels.com

2. Air Pollution and Cardiovascular Risk

According to the Environmental Protection Agency (EPA, 2023), fine particulate matter (PM2.5) and volatile organic compounds (VOCs) found in car exhaust, industrial emissions, and household cleaners contribute to heart disease, strokes, and high blood pressure.

  • PM2.5 particles enter the bloodstream, causing inflammation, arterial stiffness, and increased clotting risk.
  • Long-term exposure is linked to a higher risk of heart attacks and strokes (Brook et al., 2023).

Functional Medicine Solution:
✅ Use HEPA air filters indoors to reduce pollution exposure.
✅ Reduce time spent near high-traffic areas and industrial zones.
✅ Support detoxification with antioxidant-rich foods (berries, green tea, turmeric) to combat oxidative stress.

3. Endocrine Disruptors: BPA, Phthalates, and PFAS

Endocrine-disrupting chemicals (EDCs) interfere with hormone regulation, impacting blood pressure, cholesterol, and inflammation (Gore et al., 2023).

  • Bisphenol A (BPA): Found in plastic containers and canned goods, BPA mimics estrogen, increasing blood pressure and cardiovascular risk.
  • Phthalates: Common in personal care products and food packaging, phthalates contribute to metabolic syndrome and obesity, both of which impact heart health.
  • PFAS (“Forever Chemicals”): Found in non-stick cookware, water-resistant clothing, and fast food packaging, PFAS exposure is linked to high cholesterol and hypertension.

Functional Medicine Solution:
✅ Switch to glass or stainless steel containers for food storage.
✅ Avoid plastic water bottles and BPA-lined cans.
✅ Choose organic skincare and household products to reduce exposure.

4. Pesticides and Their Role in Heart Disease

Pesticides used in conventional farming contain chemicals that disrupt the nervous system, trigger inflammation, and increase oxidative stress, all of which are linked to hypertension and cardiovascular dysfunction (Mostafalou & Abdollahi, 2022).

  • Glyphosate, commonly used in herbicides, has been linked to gut microbiome disruption and increased risk of metabolic disorders that impact heart health.
  • Organophosphate pesticides contribute to vascular dysfunction and arterial stiffness.

Functional Medicine Solution:
✅ Choose organic fruits, vegetables, and grains to reduce pesticide intake.
✅ Wash produce with baking soda or vinegar to remove residues.
✅ Support detoxification with cruciferous vegetables (broccoli, Brussels sprouts, cabbage).

5. Mold and Mycotoxins: A Hidden Threat to Heart Health

Mold exposure—often from water-damaged buildings, contaminated foods, or poor ventilation—produces mycotoxins that trigger chronic inflammation and vascular damage.

  • Mycotoxins like ochratoxin A and aflatoxins are linked to hypertension, blood vessel dysfunction, and oxidative stress (Hope et al., 2022).

Functional Medicine Solution:
✅ Check for mold in homes and workplaces, and use air purifiers.
✅ Consume binders like activated charcoal and bentonite clay to detox mycotoxins.
✅ Support liver detoxification with milk thistle and glutathione.

Photo by Arnie Watkins on Pexels.com

How to Reduce Toxic Burden and Protect Your Heart

A functional medicine approach emphasizes detoxification, nutrient optimization, and lifestyle interventions to minimize toxin exposure and support cardiovascular health.

1. Eat a Heart-Healthy, Detox-Supporting Diet

🥦 Cruciferous vegetables (broccoli, kale) support liver detox.
🍋 Lemon water and dandelion tea enhance natural detoxification.
🐟 Omega-3 fatty acids (wild-caught salmon, flaxseeds) reduce inflammation from toxin exposure.
🌾 Fiber-rich foods (chia seeds, psyllium husk) help eliminate toxins through digestion.

2. Sweat Out Toxins

🚴 Exercise regularly to stimulate the lymphatic system and circulation.
🧖‍♀️ Infrared sauna therapy promotes detoxification through sweat.

3. Improve Detox Pathways with Targeted Nutrients

🌿 Glutathione: The body’s master antioxidant, essential for detox.
💊 N-acetyl cysteine (NAC): Supports liver function and heavy metal clearance.
🫐 Antioxidants (vitamin C, quercetin): Combat oxidative stress from toxins.

4. Reduce Chemical Exposure in Your Home

🏡 Use natural cleaning products (vinegar, baking soda) instead of chemical-based cleaners.
🌱 Switch to organic personal care products to avoid phthalates and parabens.
💧 Install water filters to remove heavy metals and chemicals from drinking water.

Bringing it all together!

Hidden toxins are a silent contributor to heart disease, impacting blood pressure, cholesterol, and arterial health. By identifying sources of toxic exposure, supporting detox pathways, and adopting a functional medicine approach, you can protect your heart and overall health.

Reducing environmental toxins isn’t about perfection—it’s about progress. Small, mindful changes can make a big difference in long-term cardiovascular wellness.

Written By: Roxanne Oliver, DNP, APRN, FNP-BC, CHHP

*The information contained in this post is for information only. It does not replace routine follow-up and/or care with a certified and licensed medical provider

References

American Heart Association. (2023). Environmental toxins and cardiovascular health. Retrieved from https://www.heart.org

Brook, R. D., Rajagopalan, S., Pope, C. A., et al. (2023). Air pollution and cardiovascular disease. Circulation, 147(5), 490-509.

Environmental Protection Agency. (2023). Air pollution and heart disease risk. Retrieved from https://www.epa.gov

Gore, A. C., Crews, D., Doan, L. L., et al. (2023). Endocrine-disrupting chemicals: Impacts on cardiovascular health. Endocrine Reviews, 44(3), 233-256.

Embracing Sexual Health During Perimenopause and Menopause

by Roxy Functional Wellness, posted in Hormone Health

Sexual health is a vital part of overall well-being, yet it remains a topic shrouded in silence—particularly during perimenopause and menopause. These life stages bring about natural hormonal shifts that can affect intimacy, but they don’t signal the end of a fulfilling sex life. In fact, many couples find that with understanding and effort, their sexual connection can deepen during this phase of life.

Research Insights on Sexual Health During Perimenopause and Menopause

Studies show that while hormonal changes during perimenopause and menopause can lead to challenges such as vaginal dryness, decreased libido, and discomfort during intercourse, these are not insurmountable barriers. Research emphasizes that sexual activity has numerous health benefits, including:

  • Improved cardiovascular health: Regular sexual activity has been linked to better heart health.
  • Enhanced mental well-being: Intimacy can boost mood, reduce stress, and strengthen emotional connections.
  • Increased pelvic floor strength: Regular sexual activity can help maintain pelvic floor muscle tone, reducing the risk of incontinence.
  • Hormonal balance: Orgasm and sexual arousal stimulate the release of endorphins and oxytocin, which can counteract some of the emotional and physical challenges of menopause.
Photo by RDNE Stock project on Pexels.com

Common Challenges Faced by Women

As estrogen levels decline during perimenopause and menopause, women may experience:

  • Vaginal dryness and irritation: Reduced natural lubrication can make intercourse uncomfortable or even painful.
  • Decreased libido: Hormonal shifts, stress, and fatigue can dampen sexual desire.
  • Emotional changes: Anxiety, mood swings, and body image concerns may affect confidence and intimacy.
  • Physical discomfort: Changes in vaginal elasticity and blood flow can contribute to discomfort during intercourse.

Navigating Changes with Lifestyle Adjustments

Lifestyle plays a significant role in maintaining sexual health. Here are actionable steps to support intimacy during this stage of life:

  1. Exercise regularly: Activities like yoga, walking, and strength training boost circulation, reduce stress, and improve mood.
  2. Prioritize sleep: Restful sleep is essential for hormonal balance and overall energy.
  3. Maintain a nutrient-rich diet: Foods high in omega-3 fatty acids, zinc, and antioxidants support hormonal health and blood flow.
  4. Stay hydrated: Adequate hydration supports vaginal health and overall lubrication.
  5. Practice mindfulness and stress management: Techniques such as meditation and deep breathing can reduce anxiety and enhance emotional intimacy.

Supplements and Natural Remedies

Certain supplements can help address common challenges:

  • Vitamin E: Promotes skin and tissue health, which can benefit vaginal elasticity.
  • Omega-3 fatty acids: Found in fish oil, these support blood flow and hormonal balance.
  • Maca root: An adaptogen that may enhance libido and energy.
  • Probiotics: Support vaginal flora and overall health.
  • Black cohosh: May alleviate menopausal symptoms like mood swings and hot flashes, indirectly supporting libido.

Prescription Options for Sexual Health

For those needing additional support, medical options include:

  • Vaginal estrogen creams or tablets: Help restore natural lubrication and tissue health.
  • DHEA suppositories: Support vaginal elasticity and libido.
  • Testosterone therapy: May help address decreased libido in some women.
  • Ospemifene: A non-hormonal option for vaginal dryness and discomfort.
  • Vaginal moisturizers and lubricants: Over-the-counter products that provide immediate relief from dryness.
Photo by Chidi Young on Pexels.com

The Importance of Communication

Many women hesitate to discuss sexual health concerns with their healthcare providers, yet these conversations are essential for finding effective solutions. Open dialogue with a partner is equally important. Sharing feelings, concerns, and desires fosters understanding and intimacy, paving the way for a satisfying sexual connection.

Final Thoughts

Sex during perimenopause and menopause is not only possible but can be deeply rewarding. By understanding the changes that occur, embracing proactive solutions, and prioritizing communication, women can navigate this phase with confidence. Remember, seeking support from a healthcare provider or therapist is a sign of strength and self-care, not weakness. Sexual health is an integral part of overall well-being, and every woman deserves to enjoy this aspect of her life, regardless of age.

Written By: Roxanne Oliver, DNP, APRN, FNP-BC

*The information contained in this post is for information only. It does not replace routine follow-up and/or care with a certified and licensed medical provider

References

Faubion, S. S., Rullo, J. E., & Shuster, L. T. (2015). Sexual health in midlife women. The Journal of the North American Menopause Society, 22(9), 915-927. https://doi.org/10.1097/GME.0000000000000411

Kingsberg, S. A., Schaffir, J., Faught, B. M., Pinkerton, J. V., Parish, S. J., Iglesia, C. B., … & Simon, J. A. (2019). Female sexual health: Barriers to optimal outcomes and a roadmap for improved patient–clinician communications. The Journal of Sexual Medicine, 16(9), 1214-1225. https://doi.org/10.1016/j.jsxm.2019.06.014

Portman, D. J., & Gass, M. L. S. (2014). Genitourinary syndrome of menopause: New terminology for vulvovaginal atrophy from the International Society for the Study of Women’s Sexual Health and The North American Menopause Society. The Journal of the North American Menopause Society, 21(10), 1063-1068. https://doi.org/10.1097/GME.0000000000000329

Shifren, J. L., & Gass, M. L. S. (2014). The North American Menopause Society recommendations for clinical care of midlife women. The Journal of the North American Menopause Society, 21(10), 1038-1062. https://doi.org/10.1097/GME.0000000000000319

Parish, S. J., & Clayton, A. H. (2007). Sexual medicine education: Review and commentary. The Journal of Sexual Medicine, 4(2), 259-267. https://doi.org/10.1111/j.1743-6109.2007.00425.x

Mac Bride, M. B., Rhodes, D. J., & Shuster, L. T. (2010). Vulvovaginal atrophy. Mayo Clinic Proceedings, 85(1), 87-94. https://doi.org/10.4065/mcp.2009.0413

Kingsberg, S. A., & Kellogg Spadt, S. (2018). Female sexual disorders: Assessment, diagnosis, and treatment. Obstetrics and Gynecology Clinics of North America, 45(4), 593-607. https://doi.org/10.1016/j.ogc.2018.07.008

North American Menopause Society. (2022). Menopause practice: A clinician\u2019s guide (6th ed.). Cleveland, OH: North American Menopause Society.

Levine, S. B., Burnett, A. L., Goldstein, A. T., & Rosen, R. C. (2016). Integrating sexual medicine into primary care. The Journal of Sexual Medicine, 13(7), 1093-1098. https://doi.org/10.1016/j.jsxm.2016.04.069

Simon, J. A., & Kaunitz, A. M. (2014). Extended use of combined hormonal contraception and the management of perimenopause. Obstetrics and Gynecology Clinics of North America, 41(3), 499-515. https://doi.org/10.1016/j.ogc.2014.05.002

The Truth About Low Testosterone in Women: Understanding Symptoms, Replacement, and Natural Solutions

by Roxy Functional Wellness, posted in Hormone Health

When people think of testosterone, they often associate it with men. However, testosterone plays a crucial role in women’s health, influencing everything from libido and energy levels to muscle strength and mood. Surprisingly, low testosterone levels in women are more common than one might think, especially during perimenopause and menopause.

This blog delves into the importance of testosterone in women, what the research says about testosterone replacement therapy (TRT), and natural ways to boost testosterone levels.

Testosterone in Women: What Research Says

Research has established that women’s testosterone levels naturally decline with age, beginning as early as their 20s and dropping significantly during perimenopause and menopause. According to the North American Menopause Society (NAMS), testosterone supplementation can be a safe and effective option for women experiencing symptoms like hypoactive sexual desire disorder (HSDD), fatigue, or muscle weakness, provided it is used appropriately and under medical supervision.

While testosterone replacement is not FDA-approved for women in the U.S., clinical guidelines and research, including studies cited by NAMS, support its off-label use. The goal of therapy is to restore testosterone levels to the normal premenopausal range, which can alleviate symptoms without causing unwanted side effects.

Symptoms of Low Testosterone in Women

Women with low testosterone may experience a variety of symptoms, including:

  • Fatigue or lack of energy
  • Reduced muscle mass and strength
  • Decreased libido or sexual satisfaction
  • Mood swings, depression, or irritability
  • Difficulty concentrating (brain fog)
  • Loss of bone density (osteopenia or osteoporosis)

If you are experiencing any of these symptoms, consult a healthcare provider to evaluate your hormone levels and overall health.

Natural Ways to Boost Testosterone Levels in Women

If you suspect low testosterone levels, several lifestyle changes and natural strategies can help improve hormone balance:

  1. Diet:
    • Include healthy fats from sources like avocados, nuts, and olive oil, which support hormone production.
    • Ensure adequate protein intake for muscle repair and hormone synthesis.
    • Zinc-rich foods (e.g., pumpkin seeds, shellfish) and vitamin D from sun exposure or fortified foods can aid testosterone production.
  2. Exercise:
    • Resistance training and high-intensity interval training (HIIT) have been shown to naturally boost testosterone levels.
    • Consistent physical activity improves overall hormone balance.
  3. Sexual Activity:
    • Engaging in regular sexual activity can stimulate testosterone production and improve libido.
  4. Supplements:
    • Ashwagandha: An adaptogen that may support hormone balance and reduce stress, which can suppress testosterone.
    • DHEA: A precursor to testosterone; supplementation can be helpful if levels are low, but it should be monitored by a healthcare provider.
    • Maca Root: May help improve sexual desire and balance hormones.
  5. Stress Management:
    • Chronic stress increases cortisol, which can suppress testosterone. Techniques like yoga, meditation, or mindfulness can help.
Photo by Oluremi Adebayo on Pexels.com

Who is Appropriate for Testosterone Replacement Therapy (TRT)?

TRT may be appropriate for women who:

  • Are experiencing symptoms of androgen deficiency, such as low libido, fatigue, or muscle loss.
  • Have low testosterone levels confirmed by lab testing.
  • Have not found relief through natural methods or other treatments.

TRT is NOT appropriate for women who:

  • Have a history of hormone-sensitive cancers (e.g., breast or uterine cancer).
  • Are pregnant or breastfeeding.
  • Have untreated androgen excess conditions like PCOS.

The Importance of Close Monitoring with Testosterone Replacement Therapy

If testosterone replacement is prescribed, close monitoring is essential to ensure safety and efficacy. This includes:

  • Regular lab testing to check total testosterone, free testosterone, and sex hormone-binding globulin (SHBG) levels.
  • Monitoring for side effects such as acne, hirsutism, or voice deepening.
  • Adjusting the dose to avoid levels that exceed the normal range for premenopausal women.

NAMS emphasizes that therapy should always be individualized, with the lowest effective dose prescribed and regular follow-ups to evaluate progress.

The Bottom Line

Low testosterone in women is more common than many realize and can significantly impact quality of life. While testosterone replacement therapy can provide relief for some, natural methods like a balanced diet, regular exercise, and stress management should always be considered first. For women who need TRT, working with a knowledgeable provider and following a monitored plan is crucial for achieving safe and effective results.

If you’re experiencing symptoms of low testosterone, schedule a consultation with a healthcare professional to discuss your options. With the right approach, you can regain energy, strength, and vitality.

Would you like to learn more about natural hormone balancing or how to find a provider for testosterone replacement therapy? Reach out today!

Written By: Roxanne Oliver, DNP, APRN, FNP-BC

*The information contained in this post is for information only. It does not replace routine follow-up and/or care with a certified and licensed medical provider

References

North American Menopause Society (NAMS). (2022). The 2022 hormone therapy position statement of the North American Menopause Society. Menopause, 29(7), 767-794. https://doi.org/10.1097/GME.0000000000002041

Davison, S. L., Bell, R., Donath, S., Montalto, J. G., & Davis, S. R. (2005). Androgen levels in adult females: Changes with age, menopause, and oophorectomy. Journal of Clinical Endocrinology & Metabolism, 90(7), 3847–3853. https://doi.org/10.1210/jc.2005-0212

Braunstein, G. D. (2007). Management of female sexual dysfunction in postmenopausal women by testosterone administration: Safety issues and controversies. Journal of Sexual Medicine, 4(1), 174–185. https://doi.org/10.1111/j.1743-6109.2007.00304.x

Dimitrakakis, C., & Bondy, C. (2009). Androgens and the breast. Breast Cancer Research, 11(5), 212. https://doi.org/10.1186/bcr2435

Hackett, G. (2019). Testosterone therapy for women: Indications and treatment options. Advances in Therapy, 36(9), 2210–2220. https://doi.org/10.1007/s12325-019-01015-8

Arlt, W., & Gross, C. (2013). Androgen therapy in women. European Journal of Endocrinology, 168(2), R1–R12. https://doi.org/10.1530/EJE-12-1046

Kingsberg, S. A., Clayton, A. H., & Dennerstein, L. (2005). Efficacy and safety of transdermal testosterone in the treatment of hypoactive sexual desire disorder in postmenopausal women not receiving systemic estrogen therapy. Journal of Sexual Medicine, 2(6), 716–726. https://doi.org/10.1111/j.1743-6109.2005.00095.x

Hill, P. D., & Taylor, R. W. (2020). Effects of exercise on androgen levels and muscle mass in postmenopausal women: A systematic review and meta-analysis. Sports Medicine, 50(4), 757–768. https://doi.org/10.1007/s40279-020-01250-3

Morales, A., & Lunenfeld, B. (2002). Androgen replacement therapy in aging men and women: An overview. Aging Male, 5(4), 184–197. https://doi.org/10.1080/tam.5.4.184.197

Stuenkel, C. A., Gass, M. L. S., Manson, J. E., et al. (2015). A decade after the Women’s Health Initiative—The experts do agree. Menopause, 22(6), 589–598. https://doi.org/10.1097/GME.0000000000000485

The Role of Air Quality in Hormone Balance for Men and Women

by Roxy Functional Wellness, posted in Hormone Health

Why Air Quality Matters for Hormone Balance

Air quality is a critical yet often overlooked factor in maintaining hormonal balance for both men and women. Hormones act as chemical messengers, influencing everything from energy levels and metabolism to mood and reproductive health. Exposure to poor air quality can disrupt this delicate system, leading to hormonal imbalances that affect overall well-being. Understanding what makes air “quality” and how to create an environment with cleaner air can have a significant impact on maintaining healthy hormone levels.

What Does “Quality Air” Mean?

Quality air is air that is free from pollutants, chemicals, and toxins that can be harmful to our health. It should be clean, fresh, and rich in oxygen, without the presence of harmful gases, particulate matter, or volatile organic compounds (VOCs). Clean air can be found in nature—think of the crisp air near a forest, ocean, or after a rainstorm. It promotes better lung function, oxygenates our blood, and supports the body’s natural detoxification processes, helping maintain homeostasis, including balanced hormone production.

The Importance of Fresh Air

Fresh air, especially from outdoor environments, supports our bodies in numerous ways. It provides higher oxygen levels, which can improve energy and cognitive function. Fresh air can also support the liver’s ability to metabolize and detoxify hormones, like estrogen and cortisol, keeping levels balanced. Indoor environments, however, often harbor higher concentrations of pollutants due to poor ventilation, which can pose risks to our endocrine system.

Common Air Pollutants and Their Impact on Hormones

Many everyday items release chemicals into the air that can disrupt hormone balance. These include:

  • Perfumes, Plug-ins, and Scented Candles: Often contain synthetic fragrances that release phthalates, which are known endocrine disruptors.
  • Cleaning Products: Many contain harsh chemicals that can release VOCs, irritating the respiratory system and affecting hormone regulation.
  • Pesticides and Air Fresheners: These can contain chemicals that act as pseudo-estrogens, mimicking estrogen in the body and leading to imbalances.
  • Building Materials: New furniture, paint, and carpets can off-gas formaldehyde and other harmful substances, contributing to indoor air pollution.

How Air Pollutants Act as Pseudo-Estrogens

Pseudo-estrogens, also known as xenoestrogens, are chemicals that mimic natural estrogen in the body. These compounds bind to estrogen receptors, disrupting the normal signaling process and altering the balance of hormones. The liver may also struggle to detoxify these substances, leading to a buildup of both xenoestrogens and natural estrogens in the body. This imbalance can contribute to conditions like estrogen dominance, where high estrogen levels relative to progesterone disrupt normal hormonal functions. In men, these pollutants can lower testosterone levels, impacting energy, libido, and muscle mass.

Pathophysiology of Air Pollutants and Hormone Dysregulation

Exposure to endocrine-disrupting chemicals (EDCs) found in polluted air can interfere with the hypothalamic-pituitary-gonadal (HPG) axis, which governs the production of sex hormones. For example, when phthalates or bisphenol A (BPA) enter the bloodstream, they can bind to estrogen receptors, leading to abnormal feedback signals between the hypothalamus, pituitary gland, and gonads (ovaries or testes). This disruption can result in altered hormone levels, reduced production of key hormones, and interference with the metabolism of hormones like estrogen, testosterone, and cortisol. Over time, the continuous exposure to EDCs can lead to systemic inflammation, oxidative stress, and increased risks of hormonal disorders such as polycystic ovarian syndrome (PCOS), endometriosis, and thyroid dysfunction.

Photo by Lucas Pezeta on Pexels.com

Common Symptoms of Poor Air Quality on Hormone Health

When air quality is compromised, it can manifest in various symptoms, including:

  • Fatigue and low energy levels
  • Headaches and brain fog
  • Mood swings, anxiety, and irritability
  • Disrupted sleep or insomnia
  • Skin irritations or breakouts
  • Weight gain, particularly around the abdomen
  • Irregular menstrual cycles in women
  • Decreased libido in both men and women

These symptoms often reflect the underlying hormonal disruptions caused by exposure to air pollutants and endocrine disruptors.

How to Improve Air Quality for Better Hormone Balance

Ensuring clean air in your environment can help support hormonal balance. Here are a few strategies:

  1. Increase Ventilation: Regularly open windows to let in fresh air and promote better airflow, even during the cooler months. Proper ventilation helps to reduce the buildup of indoor pollutants.
  2. Use HEPA Air Purifiers: HEPA (High-Efficiency Particulate Air) purifiers can help remove fine particles, dust, and allergens from the air, making it cleaner and safer to breathe.
  3. Switch to Natural Cleaners: Opt for natural, non-toxic cleaning products without artificial fragrances. Ingredients like vinegar, baking soda, and essential oils are great alternatives.
  4. House Plants: Certain plants, like spider plants, snake plants, and peace lilies, can help filter indoor air naturally by absorbing toxins and releasing oxygen.
  5. Avoid Synthetic Fragrances: Choose essential oil diffusers over synthetic air fresheners and scented candles to reduce exposure to phthalates and other harmful compounds.
  6. Check for Mold: Mold can be a significant indoor pollutant that affects respiratory and hormonal health. Ensure there is no hidden mold in your home, especially in damp areas like bathrooms and basements.
  7. Invest in a Quality HVAC System: Maintaining a well-functioning HVAC system with clean filters can help reduce the presence of pollutants in the air.

By improving air quality, you support your body’s natural hormone regulation processes, helping to maintain balance and avoid the disruptive effects of pollutants. Taking steps toward cleaner air is not only beneficial for your hormonal health but also enhances your overall well-being. Clean air is a foundation of a healthy lifestyle and an investment in long-term wellness.

Written By: Roxanne Oliver, DNP, APRN, FNP-BC

*The information contained in this post is for information only. It does not replace routine follow-up and/or care with a certified and licensed medical provider

References

Dodson, R. E., Nishioka, M., Standley, L. J., Perovich, L. J., Brody, J. G., & Rudel, R. A. (2012). Endocrine disruptors and asthma-associated chemicals in consumer products. Environmental Health Perspectives, 120(7), 935-943. https://doi.org/10.1289/ehp.1104052

Diamanti-Kandarakis, E., Bourguignon, J. P., Giudice, L. C., Hauser, R., Prins, G. S., Soto, A. M., … & Gore, A. C. (2009). Endocrine-disrupting chemicals: An Endocrine Society scientific statement. Endocrine Reviews, 30(4), 293-342. https://doi.org/10.1210/er.2009-0002

Gore, A. C., Chappell, V. A., Fenton, S. E., Flaws, J. A., Nadal, A., Prins, G. S., … & Zoeller, R. T. (2015). Executive summary to EDC-2: The Endocrine Society’s second scientific statement on endocrine-disrupting chemicals. Endocrine Reviews, 36(6), 593-602. https://doi.org/10.1210/er.2015-1093

Hug, C., & Vogel, N. (2021). Indoor air pollution and its impact on human health. Environmental Research, 194, 110714. https://doi.org/10.1016/j.envres.2020.110714

Jurewicz, J., & Hanke, W. (2011). Exposure to phthalates: Reproductive outcomes and children health. Environmental International, 37(5), 922-934. https://doi.org/10.1016/j.envint.2011.03.001

Kelly, F. J., & Fussell, J. C. (2015). Air pollution and public health: Emerging hazards and improved understanding of risk. Environmental Geochemistry and Health, 37(4), 631-649. https://doi.org/10.1007/s10653-015-9720-1

Kortenkamp, A. (2007). Ten years of mixing cocktails: A review of combination effects of endocrine-disrupting chemicals. Environmental Health Perspectives, 115(S-1), 98-105. https://doi.org/10.1289/ehp.9357

Landrigan, P. J., Fuller, R., Acosta, N. J. R., Adeyi, O., Arnold, R., Basu, N., … & Zhong, M. (2018). The Lancet Commission on pollution and health. The Lancet, 391(10119), 462-512. https://doi.org/10.1016/S0140-6736(17)32345-0

Tran, T. M., & Kannan, K. (2015). Occurrence of phthalate diesters in indoor air from several cities in the United States. Environmental Science & Technology, 49(3), 1277-1283. https://doi.org/10.1021/es504805n

Weschler, C. J., & Nazaroff, W. W. (2010). SVOC partitioning between the gas phase and settled dust indoors. Atmospheric Environment, 44(30), 3609-3620. https://doi.org/10.1016/j.atmosenv.2010.06.029

Yang, C., Liu, H., & Guo, Y. (2020). Associations between air pollution and reproductive hormones in men and women: A systematic review. Environmental Research, 188, 109779. https://doi.org/10.1016/j.envres.2020.109779

Zoeller, R. T., Brown, T. R., Doan, L. L., Gore, A. C., Skakkebaek, N. E., Soto, A. M., … & Vom Saal, F. S. (2012). Endocrine-disrupting chemicals and public health protection: A statement of principles from The Endocrine Society. Endocrinology, 153(9), 4097-4110. https://doi.org/10.1210/en.2012-1422

Managing Hot Flashes and Night Sweats in Perimenopause: A Guide to Functional and Conventional Treatments

by Roxy Functional Wellness, posted in Hormone Health

Perimenopause marks the transition period leading up to menopause, typically beginning in a woman’s 40s but sometimes as early as the mid-30s. It’s a phase characterized by hormonal changes that gradually lead to the end of reproductive years. Unlike menopause, which is defined as the absence of a menstrual period for 12 consecutive months, perimenopause can span several years, with symptoms fluctuating throughout this time. It is essential to understand that perimenopause is not a disease but a natural stage in every woman’s life.

What Happens with Hormones During Perimenopause?

During perimenopause, the body experiences fluctuations in the levels of estrogen and progesterone, the key hormones responsible for regulating the menstrual cycle and supporting reproductive health. Here’s a simplified breakdown of what happens:

  1. Decline in Ovarian Function: The ovaries, which produce estrogen and progesterone, start to lose their consistency in hormone production. This inconsistency leads to irregular menstrual cycles.
  2. Estrogen Levels Fluctuate: Estrogen levels can vary significantly during perimenopause, sometimes rising but often declining as the ovaries prepare for the end of reproductive function. These fluctuations are largely responsible for symptoms like hot flashes and night sweats.
  3. Decreased Progesterone: As ovulation becomes irregular, progesterone levels drop more consistently. Progesterone’s calming effect is lost, leading to increased anxiety, sleep disturbances, and mood changes.
  4. Impact on Other Hormones: The hypothalamic-pituitary (HP) axis plays a crucial role in hormone regulation. As estrogen and progesterone levels change, the HP axis may become more active, leading to increased secretion of luteinizing hormone (LH) and follicle-stimulating hormone (FSH). These changes can result in the classic symptoms of perimenopause.

Hot Flashes and Night Sweats: What’s Happening Physiologically?

Hot flashes and night sweats are among the most common symptoms of perimenopause. They occur due to changes in how the body regulates temperature, primarily driven by fluctuating estrogen levels. Here’s a closer look at the physiological process:

  • Vasomotor Instability: The hypothalamus, which regulates body temperature, becomes more sensitive to minor changes in estrogen levels. This sensitivity can cause the body to misinterpret small variations in temperature, triggering a heat release in the form of a hot flash.
  • Dilated Blood Vessels: During a hot flash, blood vessels near the skin’s surface dilate to release heat, causing a sudden feeling of warmth that can spread over the chest, neck, and face. This process can be accompanied by increased heart rate and sweating, known as a “vasomotor response.”
  • Night Sweats: Similar to hot flashes, night sweats are intense periods of sweating that occur during sleep, often leading to disrupted sleep and discomfort. They are a direct result of the body’s attempt to cool itself down rapidly due to changes in estrogen levels.
Photo by Kindel Media on Pexels.com

Functional Medicine Approaches for Managing Hot Flashes and Night Sweats

Functional medicine focuses on addressing the root cause of symptoms through a holistic and individualized approach. For perimenopausal symptoms like hot flashes and night sweats, the goal is to balance hormone levels and support the body through this natural transition.

  1. Hormone Balancing Through Phytoestrogens: Herbs like Black Cohosh, Red Clover, and Dong Quai can mimic estrogen’s effects in the body and provide relief from hot flashes. Phytoestrogens work more gently than synthetic hormones, offering a safer alternative with fewer side effects.
  2. Nutritional Support: Supporting liver health is crucial for hormone detoxification. A diet rich in cruciferous vegetables (like broccoli and kale) and foods high in omega-3 fatty acids (such as flaxseeds and fish) can promote hormonal balance. Additionally, magnesium, B vitamins, and vitamin D can support adrenal health and improve stress response, reducing the frequency of night sweats.
  3. Acupuncture and Mind-Body Practices: Acupuncture has been shown to alleviate hot flashes by regulating the hypothalamic-pituitary axis and balancing energy flow in the body. Techniques like yoga, meditation, and breathwork can also help manage stress and improve sleep quality, reducing the severity of symptoms.
  4. Lifestyle Modifications: A consistent sleep routine, maintaining a cool sleeping environment, and engaging in regular exercise can all play a role in reducing the severity of hot flashes and night sweats. These habits support overall well-being and can improve how the body manages hormonal changes.

Conventional Treatment Options: Pros, Cons, and Considerations

Conventional medicine offers various treatment options for managing perimenopausal symptoms, each with its own set of benefits and challenges.

  1. Hormone Replacement Therapy (HRT): HRT is one of the most common conventional approaches, involving estrogen or a combination of estrogen and progesterone. It can be highly effective for alleviating hot flashes and night sweats but comes with considerations:
    • Pros: Provides rapid relief from severe symptoms, supports bone density, and can improve overall quality of life.
    • Cons: Increased risk of blood clots, stroke, and certain cancers (such as breast and uterine cancer). HRT is often not recommended for women with a history of cardiovascular conditions or hormone-sensitive cancers.
    • Cost: HRT can be costly, depending on the formulation (pills, patches, creams) and the need for regular monitoring by a healthcare provider.
  2. Non-Hormonal Medications: SSRIs (Selective Serotonin Reuptake Inhibitors) or SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors) can help with hot flashes in some women by regulating neurotransmitter levels.
    • Pros: Suitable for women who cannot take HRT due to medical contraindications.
    • Cons: Potential side effects include nausea, dizziness, and changes in appetite or weight. These medications do not address the root hormonal changes but rather manage symptoms.
    • Cost: Generally less expensive than HRT but may require trial and error to find the right medication and dosage.

Normalizing Conversations About Perimenopause

Perimenopause is a normal, natural phase of life that many women experience. Yet, it remains a topic shrouded in discomfort and misunderstanding. By normalizing discussions about perimenopause and the accompanying symptoms, we can create a supportive environment for women navigating this transition. Understanding that hot flashes and night sweats are not “abnormal” but are part of the body’s adjustment process can help reduce anxiety and promote a sense of empowerment.

It is vital to acknowledge that every woman’s experience with perimenopause is unique, and there is no one-size-fits-all solution. A functional medicine approach emphasizes personalization, supporting women holistically through lifestyle, nutrition, and natural remedies. Meanwhile, conventional medicine offers targeted options that may suit those with more severe symptoms. Together, these approaches can provide a balanced path forward for women seeking relief during this significant life change.

Written By: Roxanne Oliver, DNP, APRN, FNP-BC

*The information contained in this post is for information only. It does not replace routine follow-up and/or care with a certified and licensed medical provider

References

Freeman, E. W., Sammel, M. D., Lin, H., & Gracia, C. R. (2015). The role of anxiety and hormonal changes in menopausal hot flashes. Menopause, 22(1), 45-51. https://doi.org/10.1097/GME.0000000000000283

Geller, S. E., & Studee, L. (2006). Botanical and dietary supplements for menopausal symptoms: What works, what does not. Journal of Women’s Health, 15(7), 634-649. https://doi.org/10.1089/jwh.2006.15.634

Harlow, S. D., Gass, M., Hall, J. E., Lobo, R., Maki, P., Rebar, R. W., & Sherman, S. (2012). Executive summary of the Stages of Reproductive Aging Workshop + 10: Addressing the unfinished agenda of staging reproductive aging. Menopause, 19(4), 387-395. https://doi.org/10.1097/gme.0b013e31824d8f40

Kaunitz, A. M., & Manson, J. E. (2015). Management of menopausal symptoms. Obstetrics & Gynecology, 126(4), 859-876. https://doi.org/10.1097/AOG.0000000000001058

Newton, K. M., Reed, S. D., & LaCroix, A. Z. (2014). Treatment of vasomotor symptoms of menopause. American Journal of Medicine, 127(3), 236-243. https://doi.org/10.1016/j.amjmed.2013.11.003

Shifren, J. L., & Gass, M. L. (2014). The North American Menopause Society recommendations for clinical care of midlife women. Menopause, 21(10), 1038-1062. https://doi.org/10.1097/gme.0000000000000319

Stuenkel, C. A., Davis, S. R., Gompel, A., Lumsden, M. A., Murad, M. H., Pinkerton, J. V., & Santen, R. J. (2015). Treatment of symptoms of the menopause: An Endocrine Society clinical practice guideline. Journal of Clinical Endocrinology & Metabolism, 100(11), 3975-4011. https://doi.org/10.1210/jc.2015-2236

van Driel, C. M., Stuursma, A., & Schneider, H. P. (2018). Efficacy and safety of herbal medicines in perimenopausal and postmenopausal disorders: A systematic review. Maturitas, 111, 1-15. https://doi.org/10.1016/j.maturitas.2018.01.009

Warren, M. P., & Shortle, B. (2016). Use of antidepressants for management of hot flashes. Journal of the American Medical Association, 315(22), 2484-2485. https://doi.org/10.1001/jama.2016.5691

Wuttke, W., Gorkow, C., Seidlova-Wuttke, D. (2006). Effects of Black Cohosh on estrogen-dependent tissues in postmenopausal women. Menopause, 13(2), 185-196. https://doi.org/10.1097/01.gme.0000179045.79338.3c

Understanding the Importance of a Balanced Diet for Women’s Hormonal Health

by Roxy Functional Wellness, posted in Health & Wellness

Hormonal balance is foundational for a woman’s overall wellness, affecting everything from mood to metabolism, reproductive health, and energy levels. Central to this balance is the complex interaction between hormones like estrogen, progesterone, and thyroid hormones, which are regulated through the hypothalamic-pituitary-thyroid (HPT) axis as well as the hypothalamic-pituitary-gonadal (HPG) axis. A balanced diet is not just about maintaining weight—it plays a pivotal role in regulating hormones, supporting the menstrual cycle, and promoting optimal well-being.

A Breakdown of Female Hormones, the Thyroid, and the HP Axis Feedback Loop

The hypothalamus and pituitary gland work in harmony to regulate the production of hormones through complex feedback loops involving both the ovaries and the thyroid gland. Here’s how each part fits together:

  • Hypothalamus: It releases Gonadotropin-Releasing Hormone (GnRH) to regulate reproductive hormones, and Thyrotropin-Releasing Hormone (TRH) to control thyroid function. These signals guide the pituitary gland in releasing other hormones.
  • Pituitary Gland: It releases Follicle-Stimulating Hormone (FSH) and Luteinizing Hormone (LH) for ovarian function, as well as Thyroid-Stimulating Hormone (TSH) to regulate the thyroid gland. TSH stimulates the thyroid to produce thyroid hormones.
  • Thyroid Gland: It produces thyroxine (T4) and triiodothyronine (T3), which play a crucial role in metabolism, energy levels, and even the regulation of sex hormones. Adequate levels of thyroid hormones ensure that the body has the right amount of energy, and they influence the menstrual cycle by affecting the ovaries and the production of estrogen and progesterone.
  • Ovaries: In response to FSH and LH, the ovaries produce estrogen and progesterone, which have various effects on the body, including regulating the menstrual cycle, mood, and energy levels. These hormones also interact with thyroid hormones, emphasizing the importance of a well-functioning thyroid for overall hormonal balance.

The Menstrual Cycle and Hormonal Shifts

The menstrual cycle is typically around 28 days, divided into four phases:

  1. Menstrual Phase (Days 1-5): This is when the uterine lining sheds, resulting in menstruation. Hormones like estrogen and progesterone are at their lowest, while T3 and T4 levels need to remain balanced for energy levels and mood.
  2. Follicular Phase (Days 1-14): During this time, FSH stimulates the ovaries to produce follicles. Estrogen levels rise, thickening the uterine lining and preparing for a potential pregnancy. Healthy thyroid function supports this phase by maintaining energy and supporting metabolic rate.
  3. Ovulatory Phase (Day 14): A surge in LH triggers ovulation, where the mature egg is released from the ovary. Estrogen peaks and drops right after ovulation. The thyroid’s role in metabolism helps sustain the energy demands during this phase.
  4. Luteal Phase (Days 15-28): After ovulation, progesterone levels rise, preparing the uterine lining for implantation. If no fertilization occurs, progesterone and estrogen levels drop, leading to the start of a new cycle. The thyroid continues to play a role in mood and energy regulation, helping to prevent symptoms like fatigue and irritability.
Photo by Jane Trang Doan on Pexels.com

The Role of Macros in Hormonal Balance and Wellness

A balanced diet with the right macronutrients—protein, fats, and carbohydrates—is crucial for hormone regulation, including the thyroid:

  • Protein: Essential amino acids from protein serve as building blocks for hormone synthesis, especially for peptide hormones like insulin and TSH. Protein also supports muscle mass, helps stabilize blood sugar levels, and can reduce cravings, which is vital for maintaining energy levels throughout the menstrual cycle. Adequate protein is also necessary for the conversion of T4 to the active T3 hormone.
  • Fats: Healthy fats, particularly omega-3s and monounsaturated fats, are crucial for producing steroid hormones like estrogen and progesterone. Fat also aids in the absorption of fat-soluble vitamins (A, D, E, and K) that are vital for hormone production. These vitamins play a role in thyroid health as well, with vitamin D being particularly important for thyroid function. Avocados, nuts, seeds, and oily fish are excellent sources of healthy fats.
  • Carbohydrates: Carbs provide the energy needed for the functioning of the brain and muscles, especially during the follicular and ovulatory phases when energy demands may increase. The thyroid is highly sensitive to calorie restriction, and maintaining adequate carb intake can prevent disruptions in T3 production. Complex carbohydrates like sweet potatoes, whole grains, and legumes help maintain stable blood sugar levels, reducing mood swings and supporting steady energy levels.
  • Calories: Undereating can throw off the balance of the HPT and HPG axes, leading to conditions like hypothalamic amenorrhea, where the menstrual cycle stops due to insufficient caloric intake. Adequate calories ensure the body has enough energy for essential functions, including hormone production and thyroid regulation.

Timing Nutrition with the Menstrual Cycle

Women who are cycling can benefit from adjusting their diet according to the phases of their menstrual cycle:

  • Follicular Phase: Focus on foods rich in phytoestrogens like flaxseeds, soy, and leafy greens to support rising estrogen levels. Protein-rich meals and whole grains help stabilize energy levels.
  • Ovulation: This is an excellent time to consume foods that support egg release and reduce inflammation, like antioxidant-rich fruits (berries, citrus fruits) and omega-3-rich foods like salmon and walnuts.
  • Luteal Phase: As progesterone levels rise, it’s beneficial to focus on foods that support this hormone, such as pumpkin seeds, nuts, and magnesium-rich foods like spinach and bananas. These can help mitigate symptoms like PMS, bloating, and mood swings.

Addressing Common Female Health Complaints with Diet

Many women have similar complaints regarding a certain time in their cycle. A balanced diet can alleviate many common menstrual complaints:

  • Painful Period Cramps: Omega-3 fatty acids, found in fish oil and chia seeds, can reduce inflammation and alleviate cramps. Magnesium-rich foods like dark chocolate and leafy greens can relax muscles and reduce pain.
  • Heavy Periods: Iron-rich foods like red meat, lentils, and spinach can help replenish lost iron during heavy menstrual bleeding. Vitamin C-rich foods, such as bell peppers and oranges, aid in iron absorption.
  • Headaches and Mood Swings: Balanced meals with complex carbs, healthy fats, and protein help maintain stable blood sugar levels, which can reduce headaches and mood swings. Foods rich in B vitamins, like eggs and whole grains, support neurotransmitter function, positively impacting mood.
  • Acne: Reducing refined sugars and focusing on whole, unprocessed foods can balance insulin levels, reducing hormonal acne. Zinc-rich foods like pumpkin seeds and chickpeas support skin health and reduce inflammation.
Photo by cottonbro studio on Pexels.com

Utilizing Supplements for Hormonal Balance and Support

A balanced diet is most effective when complemented with targeted supplements for hormonal health. Additionally, a balanced diet also provides additional support to the liver which is needs to filter through hormones efficiently:

  1. Fiber: Supports the elimination of excess estrogen by promoting healthy bowel movements, which is essential for hormone detoxification.
  2. Probiotics: A healthy gut microbiome plays a role in estrogen metabolism. Probiotics can support digestion and reduce symptoms like bloating.
  3. Magnesium: Helps alleviate cramps and reduce PMS symptoms by relaxing muscles and regulating neurotransmitters.
  4. Omega-3 Fish Oil: Reduces inflammation and supports the production of hormones that regulate mood and reduce menstrual pain.
  5. Zinc: Supports the immune system and helps with hormone production, which can be beneficial for managing acne and reducing inflammation.
  6. B-Complex Vitamins: Essential for energy production and supporting adrenal and thyroid health, which is especially important during times of stress or hormonal imbalance.
  7. Vitamin D: Supports immune function and plays a role in hormone production, including thyroid regulation, which can improve mood and energy levels.
  8. Digestive Enzymes: Aid in the breakdown of food and absorption of nutrients, ensuring that the body can utilize the vitamins and minerals necessary for hormone production.
  9. Ashwagandha: An adaptogenic herb that helps balance cortisol levels and supports the adrenal glands, helping to manage stress and stabilize energy levels.
  10. Selenium: Essential for thyroid function and the conversion of T4 to T3, making it crucial for maintaining balanced thyroid hormones.

Final Thoughts

Hormonal balance is a delicate dance, influenced by diet, lifestyle, and stress levels. By understanding the intricate relationships between macronutrients, the thyroid, the menstrual cycle, and targeted supplementation, women can create a diet that supports their unique needs throughout each phase of the cycle. A balanced diet not only nourishes the body but also serves as a powerful tool in managing common hormonal complaints and fostering overall wellness.

Written By: Roxanne Oliver, DNP, APRN, FNP-BC

*The information contained in this post is for information only. It does not replace routine follow-up and/or care with a certified and licensed medical provider

References

Dinh, K. M., & Kittnar, O. (2020). The role of thyroid hormones in cardiovascular diseases: Focus on atrial fibrillation. Physiological Research, 69(3), 509-517. https://doi.org/10.33549/physiolres.934437

Gordon, J. L., Girdler, S. S., Meltzer-Brody, S. E., Stuebe, A., & Rubinow, D. R. (2022). Hormone replacement therapy for the prevention of perimenopausal depression. American Journal of Psychiatry, 179(3), 196-206. https://doi.org/10.1176/appi.ajp.2021.21010048

Li, T., Zhang, Y., Liu, Y., & Jiang, J. (2021). The role of omega-3 polyunsaturated fatty acids in the prevention and treatment of depressive disorders: A systematic review and meta-analysis. Journal of Affective Disorders, 279(2), 580-593. https://doi.org/10.1016/j.jad.2020.09.017

Murdoch, C., Collins, C. E., & MacDonald-Wicks, L. (2021). Magnesium and its role in the prevention and management of chronic disease. Nutrients, 13(11), 3742. https://doi.org/10.3390/nu13113742

Nisar, T., & Ullah, R. (2020). Zinc in the prevention and treatment of acne: A systematic review. Journal of Dermatological Treatment, 31(1), 4-8. https://doi.org/10.1080/09546634.2019.1582062

Ortiz, R., & Herrero, E. (2020). The role of probiotics in women’s health. Journal of Applied Microbiology, 128(4), 947-962. https://doi.org/10.1111/jam.14425

Smith, K. B., & Smith, M. S. (2020). Dietary interventions in the management of iron-deficiency anemia. Journal of Clinical Medicine, 9(9), 2915. https://doi.org/10.3390/jcm9092915

Stachenfeld, N. S., & Taylor, H. S. (2021). Exercise and estrogen: The role of physical activity in women’s reproductive health. Journal of Endocrinology, 250(3), R1-R14. https://doi.org/10.1530/JOE-20-0471

Tremellen, K., & Pearce, K. (2020). Nutrition and diet in the management of polycystic ovary syndrome (PCOS). Journal of Endocrinological Investigation, 43(6), 675-688. https://doi.org/10.1007/s40618-020-01203-3

Zeng, X., Hu, X., Yu, X., & Cheng, X. (2021). The role of vitamin D in female reproductive health and pregnancy. Frontiers in Endocrinology, 12, 688884. https://doi.org/10.3389/fendo.2021.688884

Embarking on Your Weight Loss Journey: A Holistic Approach to Wellness

by Roxy Functional Wellness, posted in Health & Wellness, Weight Loss

Starting a weight loss journey can be both exciting and overwhelming. At Midwest Internal Medicine, we understand that achieving and maintaining a healthy weight is not just about aesthetics—it’s about improving overall health, well-being, and longevity. Our goal is to help you reach your healthiest self through individualized, holistic wellness plans that cater to your unique needs.

Why Striving for a Healthy Weight is Important

Maintaining a healthy weight is critical for overall health and disease prevention. According to the Centers for Disease Control and Prevention (CDC), even a modest weight loss of 5-10% of your total body weight can result in significant health benefits, such as improved blood pressure, cholesterol levels, and blood sugar management .

Here are some compelling facts from well-known health organizations that highlight the importance of maintaining a normal weight:

  • World Health Organization (WHO): Overweight and obesity are major risk factors for several chronic diseases, including diabetes, cardiovascular diseases, and cancer .
  • American Heart Association (AHA): Individuals who maintain a healthy weight can reduce the risk of heart disease by as much as 50%, lowering their chances of heart attack, stroke, and other cardiovascular conditions .
  • National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK): Obesity is linked to an increased risk of developing Type 2 diabetes, with research showing that weight loss can prevent or delay the onset of this disease .
  • Harvard T.H. Chan School of Public Health: Maintaining a healthy weight is a key component of reducing the risk of certain cancers, including breast, colon, and prostate cancers .
  • Mayo Clinic: Weight management through healthy habits like diet, exercise, and stress management is directly associated with improved longevity and quality of life .

These statistics emphasize the importance of achieving a normal weight for health and wellness. But how can you get there? Here are some essential tips that we, at Midwest Internal Medicine, integrate into our patients’ personalized wellness plans.

Photo by Antoni Shkraba on Pexels.com

The Research Behind Our Tips

1. Hydration is Key: Water plays a crucial role in digestion, detoxification, and metabolism. Research shows that drinking adequate water can increase calorie expenditure by up to 30% over a period of 60-90 minutes. Staying hydrated can also reduce hunger and support healthy digestion.

2. Holistic Eating: Eating whole, unprocessed foods helps balance blood sugar levels and provides your body with the nutrients it needs to function optimally. Consuming foods rich in fiber, lean protein, and healthy fats can increase satiety and decrease overeating . In our wellness plans, we recommend limiting gluten and dairy, as they can contribute to inflammation in some individuals.

3. Sleep Matters: Lack of sleep has been linked to increased hunger and weight gain due to the hormone imbalance it causes. A study by the National Sleep Foundation shows that individuals who get less than 7 hours of sleep per night are more likely to struggle with weight control .

4. Managing Stress: Chronic stress leads to elevated cortisol levels, which can increase appetite and cause weight gain, particularly around the abdomen . We encourage patients to incorporate mindfulness practices like yoga, meditation, or grounding exercises into their daily routines.

5. Exercise for Success: Regular physical activity, particularly strength training, is essential for maintaining muscle mass, boosting metabolism, and improving insulin sensitivity. According to the American College of Sports Medicine (ACSM), a combination of aerobic and resistance training is most effective for weight loss .

6. Gut Health: Your gut microbiome plays a critical role in digestion and weight management. Studies show that a healthy gut can improve metabolism and reduce the likelihood of obesity . Probiotic-rich foods like yogurt, kimchi, and sauerkraut can support digestive health and weight loss.

7. Spiritual Wellness: Connecting with your spiritual side, whether through meditation, mindfulness, or spending time in nature, promotes mental and emotional balance. Studies suggest that spiritual wellness can enhance physical health and improve the outcomes of a weight loss journey .

Our Holistic, Individualized Approach at Midwest Internal Medicine

At Midwest Internal Medicine, we believe that every person’s journey to wellness is unique. There is no “one-size-fits-all” solution when it comes to weight loss. That’s why we work closely with each patient to develop a comprehensive, individualized plan that includes nutrition, exercise, stress management, and spiritual wellness.

Our team uses the latest research-backed strategies to help you set realistic goals and maintain healthy habits for life. We’re proud to walk alongside you in this journey and provide ongoing support, adjustments, and encouragement as you work toward your wellness goals.

Just remember!

Achieving a healthy weight is more than just looking good—it’s about reducing the risk of chronic disease, improving your quality of life, and increasing longevity. By following research-backed tips related to hydration, whole foods, exercise, sleep, stress management, and spiritual well-being, you can make sustainable changes that lead to lasting results.

Written By: Roxanne Oliver, DNP, APRN, FNP-BC

*The information contained in this post is for information only. It does not replace routine follow-up and/or care with a certified and licensed medical provider

References
  1. Centers for Disease Control and Prevention. (2020). The health effects of overweight and obesity. CDC. https://www.cdc.gov/obesity/adult/causes.html
  2. World Health Organization. (2021). Obesity and overweight. WHO. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight
  3. American Heart Association. (2019). Weight management and cardiovascular health. AHA. https://www.heart.org/en/healthy-living/healthy-eating/losing-weight
  4. National Institute of Diabetes and Digestive and Kidney Diseases. (2022). Weight and diabetes risk. NIDDK. https://www.niddk.nih.gov/health-information/weight-management
  5. Harvard T.H. Chan School of Public Health. (2021). Weight control and cancer risk. Harvard. https://www.hsph.harvard.edu/nutritionsource/obesity-prevention
  6. Mayo Clinic. (2023). Healthy weight: Key to longevity. Mayo Clinic. https://www.mayoclinic.org/healthy-lifestyle/weight-loss
  7. Boschmann, M., & Steiniger, J. (2003). Water-induced thermogenesis. Journal of Clinical Endocrinology & Metabolism, 88(12), 6015-6019.
  8. Slavin, J. L. (2005). Dietary fiber and body weight. Nutrition, 21(3), 411-418.
  9. National Sleep Foundation. (2020). How sleep affects weight loss. NSF. https://www.sleepfoundation.org/sleep-and-weight-loss
  10. Adam, T. C., & Epel, E. S. (2007). Stress, eating and the reward system. Physiology & Behavior, 91(4), 449-458.
  11. American College of Sports Medicine. (2015). Physical activity for weight loss. ACSM. https://www.acsm.org
  12. Turnbaugh, P. J., & Gordon, J. I. (2009). The gut microbiome and obesity. Nature, 457(7228), 480-484.
  13. Koenig, H. G. (2012). Religion, spirituality, and health: The research and clinical implications. ISRN Psychiatry, 2012, 1-33.

Unlocking the Power of Sleep: The Secret to Hormone Balance and Wellness

by Roxy Functional Wellness, posted in Health & Wellness

Sleep is more than just rest—it’s a critical time when our bodies reset, heal, and regulate essential functions. The connection between sleep and the endocrine system is powerful, as sleep is necessary for proper hormone regulation. Without enough sleep, the body struggles to maintain balance, leading to weight gain, mood imbalances, and weakened immune function. If you’re looking to improve overall health and balance your hormones, understanding how sleep impacts your body is the first step.

“Many times people experience out of control cravings for different foods not because they are actually hungry, but because their body is tired and it’s trying to make that known!”

Sleep’s Vital Role in Hormone Regulation

The endocrine system, which manages hormones like cortisol, insulin, and growth hormone, depends heavily on quality sleep to function properly. When sleep is compromised, hormone levels can fluctuate, which can lead to increased stress, cravings, and weight gain. For instance, growth hormone is released during deep sleep, helping with tissue repair and muscle growth, while cortisol levels should lower at night to allow for rest and recovery. Sleep is especially important for regulating insulin, the hormone responsible for blood sugar management. Without adequate sleep, the risk of developing conditions like diabetes and obesity rises sharply.

Additionally, sleep affects hormones like ghrelin and leptin, which influence our appetite and craving control. Insufficient sleep will cause these hormones to work incorrectly and/or less effectively. Many times people experience out of control cravings for different foods not because they are actually hungry, but because their body is tired and it’s trying to make that known!

How Sleep Stages Affect Wellness

Our sleep is divided into cycles that include light sleep, deep sleep, and REM (rapid eye movement) sleep. Each stage plays a different role in supporting overall wellness, from physical repair to emotional balance. Research from the National Institutes of Health indicates that deep sleep is crucial for physical recovery, while REM sleep is vital for cognitive function and emotional processing. Without proper sleep cycles, the body cannot fully repair itself, nor can the brain properly manage emotions and cognitive functions. A healthy adult needs about 13-23% of sleep to be deep and about 20-25% to be REM. Once easy way to track this is with an Oura Ring, although sometimes cost can be a big con with those devices.

  • Light sleep: Prepares the body for deeper stages of sleep.
  • Deep sleep: Repairs muscles, boosts immune function, and releases growth hormone.
  • REM sleep: Supports brain function, mood regulation, and memory consolidation.
Photo by Brett Jordan on Pexels.com

What Happens to Your Body While You Sleep

Sleep is a time of intense biological activity, even though it feels like rest. Your body undergoes significant repair, detoxification, and growth, all powered by hormones. Growth hormone, for instance, is secreted during deep sleep, enabling muscle repair and tissue growth. Additionally, neurotransmitters like serotonin and dopamine are replenished, which helps regulate mood and mental health. Without proper sleep, these processes are disrupted, leading to fatigue, mood swings, and slower recovery from physical exertion. Our immune system also uses our sleep time to strengthen; preparing the body to fight off any potential infections.

Tips for Achieving Restful Sleep

Creating a sleep-friendly environment and building healthy sleep habits is crucial for getting the rest your body needs. Small changes in routine and lifestyle can lead to significant improvements in sleep quality. Reducing screen time before bed, maintaining a consistent bedtime, and using relaxation techniques can help you fall asleep faster and stay asleep longer. Ensuring that your bedroom is dark, quiet, and cool will also support deep, uninterrupted sleep.

  • Set a regular sleep schedule by going to bed and waking up at the same time.
  • Create a calming bedtime routine, such as reading or meditating.
  • Limit caffeine and heavy meals in the evening.
  • Make your bedroom conducive to sleep—dark, cool, and quiet.

Natural Sleep Remedies Backed by Science

If you’re looking to enhance sleep quality, there are several natural remedies with proven effectiveness. Melatonin, for example, has been shown to help regulate sleep-wake cycles, especially for people with insomnia or circadian rhythm disorders. Magnesium is another supplement that can improve sleep by calming the nervous system and reducing cortisol, the stress hormone. Studies also show that herbal remedies like valerian root and lavender oil can help ease anxiety and promote deeper sleep without the side effects of medication.

  • Melatonin: Regulates the sleep cycle; effective for people with sleep disorders.
  • Magnesium: Supports relaxation and reduces stress hormone levels.
  • Valerian root: Shown to improve sleep quality and reduce the time it takes to fall asleep.
  • Lavender essential oil: Proven to reduce anxiety and promote deeper sleep.

The Importance of Consistency in Sleep Patterns

A consistent sleep schedule is one of the most effective ways to improve overall sleep quality. By going to bed and waking up at the same time each day, your body’s internal clock (circadian rhythm) stays balanced, making it easier to fall asleep and wake up refreshed. Irregular sleep patterns can confuse your body, leading to insomnia or daytime fatigue. Even on weekends, try to stick to your regular sleep routine for the best results.

When to See a Provider About Sleep Issues

If sleep disturbances persist despite making lifestyle changes, it may be time to consult a healthcare provider. Chronic sleep issues could be signs of underlying conditions like sleep apnea, restless leg syndrome, or hormonal imbalances. Left untreated, chronic poor sleep can lead to long-term health problems, including cardiovascular disease, diabetes, and mental health disorders. A provider can help identify any underlying conditions and suggest therapies or treatments to improve sleep.

Photo by Ketut Subiyanto on Pexels.com

Sleep plays a vital role in regulating hormones, supporting immune function, and maintaining overall health. By focusing on achieving quality sleep, including deep and REM stages, we can enhance our body’s natural healing processes and improve mental clarity, mood, and physical well-being. A consistent sleep routine, paired with evidence-based natural remedies like melatonin, magnesium, and valerian root, can help ensure restful, restorative sleep. However, when sleep issues persist despite lifestyle adjustments, seeking the guidance of a healthcare provider is essential to prevent long-term health consequences. Prioritizing sleep is not just about feeling rested—it’s key to sustaining health, balance, and vitality.

Written By: Roxanne Oliver, DNP, APRN, FNP-BC

*The information contained in this post is for information only. It does not replace routine follow-up and/or care with a certified and licensed medical provider

References

Centers for Disease Control and Prevention. (2021). Sleep and sleep disorders. https://www.cdc.gov/sleep/index.html

Cleveland Clinic. (2020). How much sleep do you need? https://health.clevelandclinic.org/how-many-hours-of-sleep-do-you-actually-need/

Holistic Nursing Practice. (2019). The effect of lavender oil on sleep quality and anxiety in patients with coronary artery disease. Holistic Nursing Practice, 33(2), 95-103. https://doi.org/10.1097/HNP.0000000000000325

Journal of Research in Medical Sciences. (2012). The effect of magnesium supplementation on insomnia in elderly people. Journal of Research in Medical Sciences, 17(12), 1161-1169. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3703169/

National Institutes of Health. (2021). Sleep deprivation and deficiency. https://www.nhlbi.nih.gov/health-topics/sleep-deprivation-and-deficiency

National Sleep Foundation. (2020). How much sleep do we really need? https://www.sleepfoundation.org/how-sleep-works/how-much-sleep-do-we-really-need

PubMed. (2016). Valerian root improves sleep quality and reduces sleep latency. Complementary Therapies in Medicine, 27, 41-48. https://doi.org/10.1016/j.ctim.2016.06.012

Sleep Foundation. (2021). REM sleep: What is it and how much do you need? https://www.sleepfoundation.org/how-sleep-works/rem-sleep