Aviva Romm MD is a world renown midwife and herbalist who also happens to be a Yale trained MD and Board Certified Family Physician with specialties in Integrative Gynecology, Obstetrics and Pediatrics, and is also a Sakara Medical Advisory Board member. Her new book "Hormone Intelligence" explores the impact of the world we live in on women’s hormones and health, and offers a new medicine that balances the holistic with the best science has to offer.
Dr. Aviva Romm is a woman whisperer. Her insight is the result of decades as a midwife, MD, herbalist, ecologist, author, and if that’s not a full-enough resume—mother of four. Romm’s advice is no-nonsense, empowering, and rooted deeply in the food-as-medicine philosophy; after all, her understanding of hormonal synergy was a key reason we tapped her to help us create Level II, our expert-level whole food detox. In our latest venture together, Dr. Romm curated a Sakara Signature Program menu of meals she deems most hormone-healing (make sure to catch it the week of June 7). She continues to show us how nourishment in all its forms puts us in the driver’s seat of preventative health.
The Sixth Vital Sign
Today, we traverse the hormone world to talk about menstruation with Romm. Period health can still seem like a taboo topic, but it’s incredibly valuable to get loud when it comes to the power of this 28-day, four-part cycle. According to Romm, who just released her new book Hormone Intelligence, menstruation—and hormonal health—is considered to be the sixth vital sign, providing insight into your vitality and well-being across all seasons of life. “Hormones influence every aspect of our health and well-being far beyond menstrual cycles, pregnancy, birth, and menopause,” Romm says. “Our hormones maintain healthy blood sugar and cholesterol levels; helps produce mood-supporting neurotransmitters like serotonin; help us to get good, refreshing sleep; maintain bone health, skin tone and hair health; allow us to build muscle and heal easily; keep our vaginas and urinary tracts healthy and comfortable; supports cognitive health, memory, executive function, and cardiovascular health; and keeps inflammation at bay. Big stuff.”
Menstruation in particular can serve as a monthly status update on your hormone health. “Our hormones, though we’re told make us totally unpredictable, are in fact very predictable—both month to month, and over the arc of our lives,” Romm says. “Despite what we’ve been taught, our cycles aren’t supposed to make us miserable—and if they are (think: period pain, pain with sex, serious mood swings, wildly irregular cycles, breasts that are too tender to touch, overwhelming fatigue, uncontrollable cravings, menstrual migraines)— something’s out of sync and these are ‘hormone alarms.’” In some reports, an estimated 80% of women deal with some sort of hormonal imbalance. If that sounds bleak, the silver lining is that nutrition and food can truly shake up your hormonal fate; you can absolutely change course through food and balance hormones. Food is the building block of these chemical messengers, after all.
Below, Dr. Aviva Romm provides the groundwork for straightforward, non-restrictive, hormone support, especially when it comes to understanding health through the lens of the four-part cycle. Find her most potent pieces of wisdom and nutrient-dense tips for strengthening and recalibrating a thriving endocrine system.
ON HOW 2020 AFFECTED OUR HORMONES:
“I decided to do a poll of my Instagram audience and learned that 38% of over 15,000 of those who polled have experienced menstrual cycle changes during the pandemic. Of these, 56% have experienced heavier periods, 44% lighter periods, 58% have experienced skipped periods, and 42% have had more frequent periods. Official research is finding similar results. We’ve known for a long time that getting even a cold or the flu can cause temporary changes to your sex hormone production and cause cycle changes, so it’s not that surpising the same would be true for a novel virus. The constant stress we’ve experienced this year can leave us in fight-or-flight mode and overload the hypothalamic-pituitary-adrenal axis, which is the pathway in our body that links our brain to our adrenal glands, the glands that produce the “stress hormone” cortisol, and that also ramps up production of adrenaline. Research has shown that chronically elevated cortisol can cause irregular or skipped periods, lack of ovulation, and hypothalamic amenorrhea. It’s all connected! This pandemic year has created the perfect storm for period problems.”
Despite what we’ve been taught, our cycles aren’t supposed to make us miserable
ON EATING DURING EACH HORMONAL PHASE:
“In Hormone Intelligence, a hormone-healing diet in general focuses on fiber, good fats, and plenty of fresh, colorful fruits and vegetables. You can also make some adjustments throughout your cycle to further support hormone health.
- Follicular phase: You can make up for menstrual blood loss with iron-rich options like dried apricots, leafy greens, lentils, and raisins.
- Ovulation: I like to recommend seeds and berries to send you into the next phase of your cycle with low inflammation.
- Luteal Phase / Premenstrually: It’s a great idea to increase your intake of healthy carbs, especially whole grains to keep cravings at bay and support mood. You can also skip the added salt during this time to avoid bloating, and instead enjoy potassium-rich veggies and fruits.
- During your flow: Keep up your premenstrual foods. A small amount of red meat is appropriate if you tend to lose a lot of blood with your period, or have some lentils or red beans if you’re vegan. Dark chocolate and healthy treats are also healthy indulgences if you’re feeling like you need a little something sweet.”
ON THE MOST POWERFUL HORMONE ALLIES:
“Leafy greens: Eat. Your. Greens. Cruciferous varieties like kale, collards, broccoli, Brussels sprouts, and broccoli sprouts contain compounds that naturally support your body’s innate detoxification processes, helping protect you from the risks of endocrine disruptors, and also help you to naturally eliminate excess estrogen. The fiber also keeps your bowels healthy, another plus for hormone health.
Seeds: Vitamin E and omega 3- and omega-6 fatty acids, which are found in flax seeds, sesame, pumpkin, and sunflower seeds are essential for hormone production and ovarian follicular function. Zinc, present in meaningful concentrations in pumpkin and sesame seeds, helps to improve the formation of the corpus luteum, progesterone levels, and gets the endometrium prepped for implantation. Seeds are rich in selenium which supports ovulation and fertility, as well as liver detoxification phases. And lignans, which flax and sesame seeds are especially rich in, are converted to enterolactone in the presence of healthy gut flora, which help keep your estrogen levels healthy.
Legumes: Legumes and beans are plant-based and provide powerful protective phytoestrogens, compounds that block and reduce the effects of hormone-disrupting environmental chemicals, known as xenoestrogens. Eating legumes two to three times a week can improve blood sugar and weight without any changes to diet or increasing exercise.”
ON HEALING PCOS + ENDOMETRIOSIS THROUGH NUTRITION:
“Though it’s important to take an individual approach to these conditions, I outline in Hormone Intelligence an advanced protocol with some functional foods and nutrients people with PCOS or endometriosis can benefit from.
- A diet that includes omega-3 fatty acids and 8-10 servings of fruits and veggies a day has been shown not only to be protective against PCOS and endometriosis but also may reduce both symptoms and underlying inflammatory and hormonal contributors to both conditions. I also recommend cutting down on red meat, as it’s been found to exacerbate several gynecologic conditions.
- NAC: N-acetyl cysteine (NAC) is a powerful antioxidant that can benefit people with either condition. It has been shown to reduce endometriosis lesions, including on the ovaries, enough to cancel surgery, and may improve pregnancy rates. In one study, it was found to be comparable to metformin in lowering insulin and androgens and improving menstrual regularity in women with PCOS.
Our hormones are in fact very predictable...over the arc of our lives
ON NOURISHING HEALTHY OVARIES:
“Your ovaries depend on vitamin C to quell the fires of oxidative stress that are generated in the highly energy intensive process of maturing your eggs for ovulation and creating the corpus luteum (the mass of cells responsible for making progesterone). This is why our ovaries are one of the highest Vitamin C concentrated areas in the body. The concentration of ascorbic acid is higher in our ovarian follicular fluid than in our blood. Because of this, make sure you’re getting plenty of fresh organic fruits and citrus. In addition, flax, pumpkin and sunflower seeds contain important micronutrients and fatty acids that can be beneficial for your menstrual cycle. For example, zinc may increase the formation of the corpus luteum and support healthy progesterone levels in the second half of the cycle.”
ON REPLETING NUTRIENTS POST-PILL:
“For some, especially if you were put on the pill for hormone-related symptoms, getting off the Pill can be a bumpier ride— it can take as long as a year or 18 months to find your cycle rhythm. I have a full post-pill plan in my book in which I recommend repleting the nutrients that the Pill depletes (ideally before discontinuing the Pill) or at the same time as you discontinue it. This can help prevent symptoms and restore the nutrients the Pill robs. This includes a multivitamin, vitamin D, and mineral supplement for at least three months post-Pill.”
ON UNLOCKING HORMONAL BLISS:
“Each lifecycle builds on the next, so a healthy hormone balance in our 20s and 30s means healthier bones, heart, and mind in our 60s and beyond—because our hormones are the sixth vital sign to our total health.”
A DEEPER DIVE INTO HORMONAL SUPPORT
A Doctor’s Guide to Fertility, Food, and Hormones
Sakara Stance on Sexual Energy
