The patient: Susan, a 42-year old engineer and mother of two, came to me complaining of acute breast tenderness before her periods.

Why she came to see me: While Susan was no stranger to changes in her breasts—she had breastfed both of her children—she was experiencing significant sensitivity in them before her periods. The tenderness would get so intense she could not hug her partner or children, and found that any jarring movement—including the jogging she loved—caused discomfort. She also complained of feeling short-tempered and “generally blue” before her periods.

How I evaluated her: Over the course of a thorough discussion, it became clear that Susan’s symptoms had started slowly but had gradually grown worse over the last three months. A breast exam revealed she had neither cysts nor lesions and, after learning that her symptoms were cyclical—they came and went with menstruation—I suspected hormonal imbalances. I ordered a 24-hour urine test on the 21st day of her cycle, which would allow me to assess her levels of estrogen, progesterone, and testosterone, as well as her levels of the stress hormones cortisol and DHEA. Further, I requested a blood test and a basal body temperature test to examine her thyroid hormone levels, which are essential to healthy ovulation (and manifest in healthy levels of progesterone).

What my evaluation revealed: Susan’s results were classic. She had an overabundance of estrogen but a shortage of progesterone, which was not a surprise given Susan’s age. Women tend to have less-robust ovulation as they mature, and ovulation helps trigger production of progesterone. ​Susan’s test results, as well as her symptoms, pointed toward “estrogen dominance”—a condition in which a woman has more estrogen than progesterone in the second half of her cycle. In addition to breast tenderness, women with estrogen dominance may also experience irritability, weepiness, frustration, moodiness, bloating, and fatigue—exactly the sort of things Susan endured every month. Additionally, she had signs of low thyroid function, which can also affect progesterone production (among other things).

How I addressed her problem: To help Susan’s body get back on track, I pinpointed three primary goals—lower her estrogen…boost her progesterone…and improve her thyroid function.

To tackle the first, we examined Susan’s diet and exercise regime. While she was an avid jogger—generally hitting the pavement two to three times a week—she admitted to “slacking off” the week before her period and not getting much other exercise besides her running. She agreed to move in some way every day—a vital component to striking hormonal balance, as working out helps one’s liver to do its job of detoxifying the body (including removing excess estrogen).

I also advised Susan to step away from processed foods and instead reach for foods that aid the liver in breaking down estrogen, such as cruciferous vegetables (broccoli, cauliflower, Brussel sprouts), which contain compounds that convert unfriendly estrogen into friendly estrogen. What this means is that our bodies are constantly breaking down hormones, including estrogen. We can break down estrogen into compounds that are “anti-proliferative,” which means anti-cancer, or those that could promote proliferation of estrogen-sensitive cells, thus becoming more pro-cancerous. The great news is that you can impact which kind of estrogen dominates with your diet! Additionally, I suggested adding beets to her plate (beets are an excellent source of betaine, which promotes hormonal balance) and sipping on dandelion tea—an herb well-reputed for its ability to diminish bloating.

I further proposed that Susan take 100 milligrams of Vitamin B6 per day. A water-soluble vitamin that’s found in turkey breast and chickpeas (among other foods), Vitamin B6 can bolster mood by activating “feel-good” hormones like dopamine and serotonin.

To boost Susan’s progesterone, I recommended balancing her estrogen and progesterone with 175 milligrams of my all-time favorite herb, chaste tree berry. It contains compounds that lower the release of luteinizing hormone from the pituitary and that, in turn, decreases the breast tenderness. Chaste tree berry also heightens progesterone production in the ovaries.

Stanford University tested a formula containing chaste tree berry, called Fertility Blend for Women, and found that the herbal combination boosted progesterone by 150%. Not only did the formula help women conceive, but it also helped them with their premenstrual symptoms. In fact, the company repackaged the product for women with PMS and hormone imbalance and called it Asensia. I’ve been using this product in my practice and it has been effective.

Hearing this, Susan was immediately on board.

Finally, I recommended a thyroid-supportive product packed with nutrients to help the conversion of the inactive thyroid hormone T4 to the active form, T3. Not only does this support progesterone production, but it also upregulates the production of energy in every cell in the body—including the ovaries. The specific supplement I proposed contained a combination of iodine, gugulipid, ashwagandha and amino acids—all of which encourage this thyroid hormone conversion. By improving her thyroid function, we would also be promoting healthier ovulation and, thus, more progesterone to balance her estrogen—which would hopefully decrease her breast tenderness.

The patient’s progress: Susan noticed an immediate improvement in her energy with the protocol I gave her. Even more exciting: The tenderness in her breasts was virtually nonexistent when her next cycle arrived. Susan remained my patient for several years, and the support I offered her in her early 40s helped her through perimenopause and later as her body transitioned at menopause. With less dramatic symptoms, she was able to not only hug her children and partner and jog…she was also able to thrive.

Click here to buy Dr. Laurie Steelsmith’s books, Natural Choices for Women’s Health, Great Sex, Naturally and Growing Younger Every Day: The Three Essential Steps for Creating Youthful Hormone Balance at Any Age.