Client Background
29-year-old female presenting with fatigue, high cholesterol and menstrual dysregulation of PMS symptoms, menorrhagia, breast tenderness and cystic acne.
Dietary history: The client consumes 3-4 meals a day consisting of cereal for breakfast with milk and a coffee, lunch is usually sushi or a chicken wrap and dinner of spaghetti, meat and potatoes or Thai takeaways 2-3 times a week.
Naturopathic considerations
Oestrogen dominance/ low progesterone to oestrogen ratio: High oestrogen can lead to menstrual irregularities which the client is experiencing.
Liver dysfunction: The liver helps remove waste, excess hormones and cholesterol from the body so when this isn’t functioning well hormones and cholesterol can accumulate, causing problematic symptoms.
Gut-Liver axis dysfunction: If gut function is impaired sluggish bowels, dysbiosis, and oestrogen can be reabsorbed, worsening oestrogen dominance. Symptoms like cyclic acne and menorrhagia can be connected to poor clearance via this route.
Blood sugar and insulin dysregulation: Fatigue, high cholesterol, and acne may suggest blood sugar imbalance or early insulin resistance. A diet heavy in simple carbs (cereal, white rice, wraps, spaghetti, takeaways) may cause insulin spikes which promotes inflammation, androgen excess, and fat storage. Insulin resistance can worsen oestrogen dominance and increase testosterone, leading to acne and PMS.
Inflammation and oxidative stress: High insulin, processed food intake, and liver burden may contribute to systemic inflammation. Chronic inflammation can impair hormone receptor sensitivity and increase symptoms of PMS, fatigue, and skin flare-ups.
Herbal Support
Silybum marianum (Milk thistle): Hepatoprotective, Phase I & II detoxification support 120 mL
Taraxacum officinale (Dandelion root): Bile stimulant, mild laxative 80 mL
Schisandra chinensis (Schisandra): Liver adaptogen, antioxidant, hormone modulator 80 mL
Vitex agnus-castus (Chaste tree): Progesterogenic, regulates menstrual cycle 60 mL
Bupleurum falcatum (Bupleurum): Liver support, stress support 60 mL
Total: 400 mL
Dosage: 5mL three times daily
Additional Recommendations
Dietary Modifications
- Increasing intake of cruciferous vegetables such as broccoli, cauliflower, brussels sprouts and cabbage to support oestrogen detoxification.
- Bitter foods like rocket, dandelion greens and lemon should be incorporated to enhance bile flow.
- Protein should be added to breakfast to help stabilise blood sugar and insulin levels.
- The client is advised to add 1–2 tablespoons of ground flaxseeds daily to support oestrogen clearance through the bowel.
- Refined carbohydrates should be replaced with complex carbohydrates such as brown rice, quinoa, oats and legumes.
Supplement Support
- Magnesium glycinate to support liver enzymes, reduce PMS symptoms, and improve sleep.
- N-acetyl cysteine to support glutathione production and antioxidant liver defence.
- Activated B-complex containing B6, B12 and folate to assist in methylation and hormone metabolism.
Lifestyle Recommendations
The client is advised to increase hydration and to limit alcohol, which burdens liver detoxification. Exposure to plastics and xenoestrogens, such as those found in cosmetics and cleaning products, should be reduced. Stress management techniques, such as yoga, meditation, or journaling, are encouraged to reduce cortisol levels, which can suppress progesterone. Regular movement, including light cardiovascular exercise and strength training, will support insulin sensitivity and hormonal balance. Sweating via sauna use or epsom salt baths may also support detoxification through the skin.
Follow-Up
At the 4-week follow-up, the client reported a noticeable increase in energy levels, as well as a reduction in menstrual pain during her last period. She also experienced a decrease in PMS symptoms, including less mood fluctuation and breast tenderness.
These improvements suggest a positive response to the herbal protocol and dietary/lifestyle changes. Compliance with the recommended plan appeared consistent, and the client expressed interest in pursuing functional testing to gain deeper insight into her underlying hormonal and metabolic concerns.