By Smriti Kochar — Functional Medicine Practitioner & Gut Health Coach
Over the last several years, I have worked closely with more than 500 women across India — women dealing with PCOS, irregular periods, unexplained weight gain, hair fall, anxiety, and chronic fatigue. They had seen gynaecologists, endocrinologists, and general physicians. Many had been prescribed hormone pills, birth control, metformin, and antidepressants. Yet the symptoms kept returning.
What I found in almost every single case surprised even me: the root cause was rarely the hormones themselves. It was the gut.
What Is the Gut-Hormone Connection?
Your gut and your hormonal system are in constant two-way communication. The gut microbiome — the ecosystem of trillions of bacteria living in your digestive tract — plays a direct role in how your body produces, activates, and eliminates hormones like oestrogen, cortisol, insulin, and thyroid hormones.
There is even a specific cluster of gut bacteria called the estrobolome, which is responsible for metabolising oestrogen. When this microbial community is disrupted — due to antibiotics, a high-sugar diet, chronic stress, or poor digestion — oestrogen is not properly cleared from the body. Instead, it gets reactivated and recirculated, leading to what clinicians call oestrogen dominance: the condition behind PCOS, fibroids, heavy painful periods, PMS, and hormonal acne.
This is not a theory. Research published in journals such as Nature Reviews Endocrinology and The Journal of Clinical Endocrinology & Metabolism confirms that gut dysbiosis — an imbalance in the gut microbiome — is directly linked to disrupted sex hormone metabolism in women.
What I See in Indian Women Specifically
India presents a unique clinical picture. Here is what I observe repeatedly across my practice:
1. Severely compromised digestive capacity
The majority of Indian women I see have low stomach acid and poor enzyme production by the time they reach their late twenties. Years of antacid use (India is one of the world's largest consumers of proton pump inhibitors), erratic meal timing, and high-carbohydrate diets leave the digestive system unable to properly break down food — particularly proteins and fats. When food is not digested, it ferments. Fermentation creates the conditions for bacterial overgrowth, leaky gut, and systemic inflammation. Inflammation is one of the strongest suppressors of progesterone production.
2. Vitamin D deficiency that is chronically underestimated
Despite living in one of the sunniest countries on Earth, the vast majority of Indian women I test are significantly deficient in Vitamin D. This matters for hormones because Vitamin D is not just a vitamin — it is a steroid hormone precursor. Low Vitamin D is associated with insulin resistance, impaired follicular development in the ovaries, and reduced anti-Müllerian hormone levels. In short: deficient Vitamin D contributes directly to PCOS and fertility challenges. Standard supplementation doses prescribed in India (60,000 IU weekly for 8 weeks) address acute deficiency but do not maintain adequate blood levels over time. I recommend consistent daily maintenance doses alongside Vitamin K2 — which ensures the Vitamin D is directing calcium to bones, not arteries.
3. Magnesium depletion from chronic stress
India is in a mental health crisis that is rarely spoken about openly. Chronic psychological stress depletes magnesium from the body at an accelerated rate. Magnesium is essential for over 300 enzymatic reactions, including the synthesis of progesterone and the regulation of cortisol. When magnesium is low, cortisol rises, progesterone falls, and the woman experiences anxiety, insomnia, period irregularity, and worsening PMS. I have seen women's symptoms improve dramatically within 4–6 weeks of correcting magnesium deficiency — before any dietary changes or other interventions.
4. A diet high in refined carbohydrates and low in bioavailable protein
The traditional Indian vegetarian diet, while rich in cultural value, is often insufficient in the amino acids required for hormone synthesis and liver detoxification. Hormones are built from cholesterol and amino acids. Without adequate protein — particularly leucine, glycine, and methionine — the liver cannot efficiently conjugate and eliminate used hormones. They accumulate. This creates the hormonal imbalances we see so commonly.
What Actually Helps: A Protocol From My Practice
After working with hundreds of women, here is the foundational protocol I return to again and again. This is not a replacement for personalised clinical care — but it addresses the root causes I see most consistently:
Step 1: Restore digestive capacity first
Before adding supplements or changing the diet, the digestive system must be able to absorb nutrients. This means addressing low stomach acid, supporting digestive enzyme production, and healing the gut lining if it is compromised. Products like a good digestive enzyme blend and a gut repair formula containing L-glutamine, zinc carnosine, and slippery elm make a measurable difference in the first 4–6 weeks.
Step 2: Correct the nutrient deficiencies driving hormonal disruption
For most Indian women, the non-negotiable foundational supplements are:
- Vitamin D3 + K2 — daily maintenance dose, not just a loading protocol
- Magnesium Glycinate — highly absorbable form, taken at night; supports sleep, cortisol regulation, and progesterone synthesis
- Bioavailable Iron — in a non-constipating form like iron bisglycinate, particularly for women with heavy periods
- Activated B-Complex — B6 and folate in their methylated forms are essential for oestrogen metabolism in the liver
Step 3: Support oestrogen clearance through the liver and gut
This is the step most practitioners miss. Once digestion is restored and deficiencies are corrected, the body needs support in clearing excess oestrogen. This happens primarily through two pathways: the liver (Phase 1 and Phase 2 detoxification) and the gut (excretion via the stool). Eating adequate fibre — particularly from cruciferous vegetables — supports both. DIM (diindolylmethane), found in broccoli and cabbage, promotes healthy oestrogen metabolism. A well-formulated liver support supplement can assist Phase 2 clearance.
Step 4: Manage cortisol — the hormone that overrides everything else
Cortisol is the master hormone. When stress is chronic and cortisol is elevated, the body steals the precursor molecules it would otherwise use to make progesterone — a phenomenon sometimes called the progesterone steal. No amount of supplementation will fully overcome this if stress is unmanaged. Magnesium helps, as does Ashwagandha (a well-researched adaptogen), but the deeper work is lifestyle: sleep before midnight, reduced caffeine, and boundaries around stimulation.
What This Means for You
If you have been told your hormones are "borderline" or that your symptoms are "just stress" — I want you to know that there is almost certainly something functional going on that has not been investigated. Hormonal symptoms do not appear out of nowhere. They are downstream of something. In my experience, that something is almost always found in the gut, the nutrient status, or the stress response.
The good news is that these are correctable. The body wants to come back into balance. It simply needs the right inputs — and a practitioner willing to look upstream of the symptoms.
If you would like to explore what might be driving your symptoms, I offer personalised consultations through smritikochar.com. And if you are ready to start with the foundational supplements, you can explore the formulations I have developed specifically for Indian women at The Science of Good Health — Women's Health Collection.
Smriti Kochar is a Functional Medicine Practitioner and India's leading Gut Health Coach, based in Gurgaon. She is the founder of The Science of Good Health and has worked with 500+ clients through her Ultrawellness Program. She was nominated as one of the top 3 wellness influencers of 2025 by Cosmopolitan India.
