The Hemp Connection [Search results for prolactin] 

As I mentioned in the first part of this series, vitex has its strongest effect on four hormones: estrogen, progesteron, luteinizing hormone (LH), and the one this post is dedicated to, prolactin.

Prolactin is primarily associated with lactation. It is also important for sexual arousal, sensing orgasms, and libido. So it's safe to say, you have to have good prolactin metabolism in order to successfully conceive and carry a pregnancy through to nursing!

One of the most important, and often overlooked, influences on prolactin function, is medication. I am most familiar with psychotropic medications because of my specialty, and I believe, with the very high incidence of anxiety, depression, and sleep disorders in women with PCOS, it is incredibly important to use these medications with discretion in order to not interfere with fertility, or successful PCOS management in women who are not in pursuit of conception.

Before considering any supplement, make a list of all the medications you've ever been prescribed and show them to a registered pharmacist. Ask them if any of those medications have any potential for disrupting prolactin function. And if you come up with a"yes" for any of them, ask for a list of alternatives that you and your prescribing physician can use to adjust your treatment plan.

When prolactin is out of balance, funny things can happen. You can produce milk when you're not supposed to (I once had a male client who started to lactate, and it turned out to be a symptom of a pituitary tumor.)

You might not be able to produce milk when you want to. Many, many, many women with PCOS find, much to their dismay, that they get pregnant, and cannot feed their babies. I am shocked at how many medical colleagues with PCOS write me to share that until they heard us mention this at inCYST…they never knew it could be a problem. And they themselves could not nurse their babies!!!

This lack of awareness and the incredible importance of healthy prolactin function to the overall health of mother and baby, is precisely why, our first outreach outside of dietitians, with inCYST, has been with lactation consultants. They understand this physiology best, and they are the most likely to pick up on problems as soon as they become apparent.

Bottom line, PCOS is not just about infertility. It is about successful reproduction, which includes being able to successfully create the next generation of healthy people.

But I digress. Back to prolactin.

Prolactin is controlled by the hypothalamus, the part of the brain we at inCYST are obsessed with learning and teaching about. The hypothalamus also regulates estrogen, progesterone, testosterone, cortisol, thyroid, and growth hormone. You can see why it's your BFF as a woman with PCOS. If you have problems with one of those, you likely have problems with more than one.

Most medical treatments address each of those hormone imbalances as if they are separate, requiring a separate medical treatment…better yet…a separate medication. So by the time you've made the specialist rounds, you've been given a birth control pill, an antidepressant, a sleep medication, a lipid lowering medication (since some of these hormones are made of cholesterol, when they're out of balance…cholesterol will be, too).

We like to think we start where the problem starts. Giving the hypothalamus what it needs to work efficiently. And the number one chemical you can focus on, which should help all of these functions, which I call our"Recipe for a Happy Hypothalamus (SM)"…is DHA, one of the fish oils.

1. DHA makes it harder for the hypothalamus to feel stress. Stress is a very selfish thing. It steals energy away from other things your body might need it for. With enough DHA in the system, the hypothalamus can put its energy into healing the functions that are NOT related to stress, mainly reproduction, sleep, and mood.

2. DHA increases dopamine receptor density. Prolactin is dopamine-controlled, meaning the more receptors there are to communicate with the dopamine that is there, the less prolactin your body needs to make.

An interesting aside--dopamine imbalance is common in people who crave and/or binge on sugar. So if you've got cravings AND your prolactin levels are not right…you just might be DHA-deficient.

I have one more post coming on chaste tree berry that will summarize important findings and recommendations.

But, with regards to prolactin, what I will say is that two very important things you can, and should, do, to move yourself back into balance, are:

1. Make sure your medications are not the source of the problem, and
2. Make sure your food choices are promoting healthy dopamine function.

Even if you DO decide to try an herbal formula, it is much more likely to work for you, if you provide it with an environment that allows it to do what it does best.

This past Wednesday, Sasha Ottey of PCOS Challenge interviewed Walter Futterweit, MD, a longtime PCOS researcher and advocate. He provided a great summary of the laboratory tests you should be getting and why. I'm providing that summary here.

If you'd like to listen to the interview with Dr. Futterweit in its entirety, please visit Sasha's Blog Talk Radio page.

Adrenal hormones--these test rule out an adrenal problem, necessary to do to be sure it's actually PCOS

17 hydroxy progesterone (drawn between 5 and 9 of a menstrual cycle)--rules out the diagnosis of nonclassic congenital adrenal hyperplasia.

(Normal levels are 15-70 ng/dl prior to ovulation, and 35-290 ng/dl during the luteal phase. )

DHEAS (dehydroepiandrosterone sulfate)

Typical normal ranges, according to NIH, for females, are:

•Ages 18 — 19: 145 — 395 ug/dL
•Ages 20 — 29: 65 — 380 ug/dL
•Ages 30 — 39: 45 — 270 ug/dL
•Ages 40 — 49: 32 — 240 ug/dL
•Ages 50 — 59: 26 — 200 ug/dL
•Ages 60 — 69: 13 — 130 ug/dL
•Ages 69 and older: 17 — 90 ug/dL

Prolactin levels, which rule out a prolactin producing tumor, as well as the effects of some medications such as Risperdal, which can elevate prolactin levels

•Non-pregnant females: 2 — 29 ng/mL

•Pregnant women: 10 — 209 ng/mL

Tests to monitor thyroid function

T4

A typical normal range is 4.5 to 11.2 micrograms per deciliter (mcg/dL).

TSH

Normal values are 0.4 — 4.0 mIU/L.

SHBG (sex hormone binding globulin) — helps to evaluate how much of your testosterone is bound/inactive and how much is free and available to cause androgen-related symptoms.

Normal values:

Follicular phase of menstrual cycle 24 — 200 nmol/L
Luteal phase of menstrual cycle 48 — 185 nmol/L
Contraceptive use 89 — 379 nmol/L
Postmenopausal 46 — 200 nmol/L

Insulin function

Fasting insulin level
Normal values: less than 13 mIU/ml

2 h glucose tolerance test
Depends on the laboratory's protocol. Typical values can be found at the link directly above.

*****************************************************************************
Dr. Futterweit did not mention vitamin D testing but since low vitamin D levels are commonly found in women with PCOS, I'd recommend that as well.

25-hydroxy vitamin D

Normal levels are 30 — 74 ng/ml

Here's a pretty large study (650 women with PCOS) that illustrates why taking care of your PCOS is not just about diet and exercise.

Smoking cigarettes may be very important in hormone function and PCOS. They found that women with PCOS who smoked, compared to women with PCOS who did not, had higher fasting blood lipids (cholesterol, triglycerides, and low-density lipoprotein) and lower prolactin levels. They also had higher adrenal responsiveness (meaning more cortisol secretion).

One of the reasons often given by women for not quitting smoking is that it helps keep weight down. But if you're doing unhealthy things to keep that weight down (restrictive dieting, smoking, diet pills, etc.), you may be making the problem you are trying to control, even worse.

Sometimes the initial weight gain that comes with quitting smoking keeps people from quitting. But if you hang in there, and keep up the other healthy behaviors you have been working on, that weight will eventually come off. It's a type of weight gain, in my opinion, that is well worth it, for the long-term gains you earn.

It's a tough one, I know…nicotine is the second most addictive substance (behind heroin) known to man…but if you can conquer the butts…you can do just about anything that comes along afterward that you decide to put your mind to.

Glintborg D, Mumm H, Hougaard DM, Ravn P, Andersen M. Smoking is associated with increased adrenal responsiveness, decreased prolactin levels and a more adverse lipid profile in 650 white patients with polycystic ovary syndrome. Gynecol Endocrinol. 2011 Jul 20. [Epub ahead of print]

The topic for this blog post was suggested by a reader. I figured it was likely important, since many of you struggle with depression and arthritis or some sort of chronic pain, and you're self-medicating. The effects of THC, the active ingredient in marijuana, on hormones, is quite extensive. I am summarizing the findings reported in the reference I list at the end. Bottom line, it's probably not the greatest idea to be regularly introducing marijuana into your system if your hormones are out of balance and you're trying to correct that problem. Even if you're not trying to become pregnant but you're sexually active. The effects outside of your own self are potentially significant.

Interestingly, improving your omega-6 to omega-3 dietary ratio helps to correct some of your own human cannabinoid levels, which may help to decrease the desire to get them from an external source. It may also alleviate the depression and joint pain that you may be using marijuana for in the first place. Some experts suggest that this imbalance of our "natural THC" may be one reason women with PCOS have strong carbohydrate cravings--it's another form of the munchies!

Reduced FSH and LH levels.
Suppressed prolactin, thyroid, growth hormone
Provokes cortisol release and reduces production of adrenal steroids, which makes it hard to maintain hormone levels.
Interferes with ovarian prostaglandin synthesis.

HCG-stimulated and FSH-stimulated progesterone secretion is inhibited.
Inhibits estradiol release.

Inhibits cholesterol esterase manufacture, and cholesterol is the building block for many reproductive hormones.
Hyperplasia and hypertrophy of the uterus
Changes in vaginal cell thickness, character and mucoid presentation
Reduced uterine weight
Suppresses thyroid function.

A dose of LH that routinely caused ovulation in normal rats was only able to induce ovulation in 40% of the rats exposed to THC.
Two to fourfold greater doses of LH were required to restore ovulation in THC-exposed rats.

The equivalent of one marijuana cigarette per day interfered with cell division and embryonic growth in fertlized eggs. It also reduced intrauterine weight gain by the fetus.

Offspring of rats exposed to THC had abnormal eggs, meaning the fertility of future generations was also affected.

Prevents reuptake of serotonin, dopamine, norepinephrine into the brain, increasing, not decreasing, depression over the long term.

Braude MC, Ludford MP, eds. Marijuana: Effects on the Endocrine Reproductive Systems. 1984

Important Lab Tests for PCOS
Many women who have PCOS have not had the correct blood work done or don't know what blood tests to ask to have done.I would like to post some important labs used to diagnose and monitor PCOS
1. Total testosterone (elevated levels are > 50ng/dl
2. Free testosterone
3. Luteinizing Hormone (LH) (plays a role in ovulation and egg development)
4. Follicle Stimulating Hormone (FSH) (responsible for egg release from the ovaries)
5. LH/FSH ratio (results should be under 2)
6. DHEA-sulfate (this test tells how much androgens or"male hormones" your body is producing) DHEA sulfate converts into testosterone.
7. Prolactin
8. Thyroid Stimulating Hormone (TSH) this test will help to rule out hypo or hyperthyroidism (slow vs fast metabolism issues)
9. Liver Function tests (LFT's). Important since medications pass through the liver, to check for possible damages. Checking every 3-6 months is recommended.
10. Fasting Lipid Profile: Total Cholesterol (<>45 mg/dl is ideal)Low Density Lipoproteins (LDL) (<130 mg/dl is ideal)Triglycerides (fat in blood) (<150 mg/dl is ideal)
11. Fasting Insulin (results should be <10) difficult to do, it needs to be frozen when brought to the lab and tested before it reaches a certain temperature, expensive but would be very beneficial in determining and monitoring insulin resistance.
12. Fasting blood chemistry panel (includes glucose, electolytes and sometimes renal labs)
13. Fasting glucose to insulin ratio (used to diagnose and monitor insulin resistance, ratio under 4.5 usually indicated insulin resistance)

Ellen Reiss Goldfarb, RD
11500 W. Olympic Blvd, Suite 400
Los Angeles, CA
310-408-1770
info@ellenreissgoldfarb.com

Here's a great summary of the effects of a high-fat diet on your hormones. A diet containing greater than 35% of calories from fat, in overweight conditions, in this study, was found to:
--disrupt 24 hour rhythms of secretion of thyroid stimulating hormone, luteinizing hormone, testosterone, and to a small extent, progesterone.
--lower total levels of thyroid stimulating hormone and testosterone.
--increase cortisol levels and disrupt the normal 24 hour cycle of cortisol release.
--induce higher blood glucose in relationship to high cortisol levels.
--reduced the magnitude of melatonin release.

So if you've got thyroid problems, can't conceive, can't sleep, and/or feel anxious or overly stressed…or have unexplainable angry outbursts…

…maybe one of the very first and most important things you can do to start to feel better…

…is reduce the amount of fat in your diet. And when you DO choose to eat fat, be sure it's the kind you see consistently recommended in our blog--seafood, nuts, canola, avocado, flax, olives.

It's really pretty simple!

Cano P, Jiménez-Ortega V, Larrad A, Toso CF, Cardinali DP, Esquifino AI. Effect of a high-fat diet on 24-h pattern of circulating levels of prolactin, luteinizing hormone, testosterone, corticosterone, thyroid-stimulating hormone and glucose, and pineal melatonin content, in rats. Endocrine. 2008 Apr;33(2):118-25. Epub 2008 May 1.

Chastetree berry is a very common supplement used by women with PCOS. Does it work? If so, how?

In order to better understand this interesting but complex herb, I thought I'd make this a series spread across several posts. I'm starting with the hormones affected by chastetree berry: luteinizing hormone (LH), estrogen, progesterone, and prolactin. Today I'll focus on LH.

Luteinizing hormone is the hormone that causes ovulation. It is also the hormone that promotes development of the follicle into a corpus luteum, the intermediary step between egg and embryo.

Luteinizing hormone is interesting in that what constitutes a"normal" level depends on what stage of a menstrual cycle you are referring to. Levels are low at the beginning of a cycle, they ramp up to a peak just before ovulation. After ovulation, they drop back down again. This graph shows a typical LH cycle in a woman who does not have PCOS.

In PCOS, there are two key variations on normal LH function to consider. First of all, when levels are supposed to be low, they tend to be high. Secondly, at the point they should be surging in order to induce ovulation, they are too low to do so. Here is a graph of LH function that is common to women with PCOS.

As you can see, restoring good LH function is not a matter of raising or lowering LH levels. It's a matter of restoring cyclicity…in other words, making sure LH is high when it should be high, and making sure it's low when it should be low. When you read information about vitex, or LH, in your own research, you should be looking for the word"normalize", rather than"raise" or"lower".

Next: a look at estrogen and ovulation.

Here's a study about lean women with PCOS--the women who I like to call"the forgotten cysters". I have lost track over the years of the number of women who have written me to share that they went to their physician asking for help with a list of PCOS symptoms they had…only to be told they couldn't possibly have PCOS because they were not overweight. Up to 70% of women who have this disorder are not overweight!!!

My belief is that many women who have adopted extreme eating and exercise behaviors to manage their weight, quite possibly many women who have been diagnosed with and who are being treated for eating disorders, actually have undiagnosed PCOS.

We need to get over this belief that thin equals healthy, and that a person cannot have PCOS if her BMI and weight are within normal limits. If you have to adopt extreme measures to stay within your recommended weight range, that is a serious problem and your physician needs to listen to you.

Now for this study to illustrate. Eight lean women who actually had been diagnosed with PCOS ("cysters") were compared to 7 lean women without PCOS. The cysters had higher testosterone, and prolactin levels. They also had lower sex hormone binding globulin levels (this protein binds and inactivates testosterone).

There you have it. You can be thin AND out of balance. Sisters…and cysters…it is your right to be heard and to not be told that nothing is wrong with you when you know there is. That is where my program name, inCYST, came from. You have the right to inCYST on the appropriate treatment for the appropriate problem and not to be told you do not need treatment just because you may not fit the common profile for PCOS, or for any disorder.

Grimmichová T, Vrbíková J, Matucha P, Vondra K, Veldhuis PP, Johnson ML. Fasting insulin pulsatile secretion in lean women with polycystic ovary syndrome. Physiol Res. 2008 Feb 13 [Epub ahead of print]

The topic for this blog post was suggested by a reader. I figured it was likely important, since many of you struggle with depression and arthritis or some sort of chronic pain, and you're self-medicating. The effects of THC, the active ingredient in marijuana, on hormones, is quite extensive. I am summarizing the findings reported in the reference I list at the end. Bottom line, it's probably not the greatest idea to be regularly introducing marijuana into your system if your hormones are out of balance and you're trying to correct that problem. Even if you're not trying to become pregnant but you're sexually active. The effects outside of your own self are potentially significant.

Interestingly, improving your omega-6 to omega-3 dietary ratio helps to correct some of your own human cannabinoid levels, which may help to decrease the desire to get them from an external source. It may also alleviate the depression and joint pain that you may be using marijuana for in the first place. Some experts suggest that this imbalance of our "natural THC" may be one reason women with PCOS have strong carbohydrate cravings--it's another form of the munchies!

Reduced FSH and LH levels.
Suppressed prolactin, thyroid, growth hormone
Provokes cortisol release and reduces production of adrenal steroids, which makes it hard to maintain hormone levels.
Interferes with ovarian prostaglandin synthesis.

HCG-stimulated and FSH-stimulated progesterone secretion is inhibited.
Inhibits estradiol release.

Inhibits cholesterol esterase manufacture, and cholesterol is the building block for many reproductive hormones.
Hyperplasia and hypertrophy of the uterus
Changes in vaginal cell thickness, character and mucoid presentation
Reduced uterine weight
Suppresses thyroid function.

A dose of LH that routinely caused ovulation in normal rats was only able to induce ovulation in 40% of the rats exposed to THC.
Two to fourfold greater doses of LH were required to restore ovulation in THC-exposed rats.

The equivalent of one marijuana cigarette per day interfered with cell division and embryonic growth in fertlized eggs. It also reduced intrauterine weight gain by the fetus.

Offspring of rats exposed to THC had abnormal eggs, meaning the fertility of future generations was also affected.

Prevents reuptake of serotonin, dopamine, norepinephrine into the brain, increasing, not decreasing, depression over the long term.

Braude MC, Ludford MP, eds. Marijuana: Effects on the Endocrine Reproductive Systems. 1984