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Aging

Who, What, and How of Hormones

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Get all the basics about hormones.  What are they? How hormones get out of balance? An overview of estrogen and progesterone and what happens when your hormones are out of balance.

  • Hot Flashes and Pro’s and Con’s of Bioidentical and Synthetic hormone replacement therapy: Dean shares her advice and medical knowledge about hot flashes. What are they? Why do they occur? How do you stop them? Plus, the pro’s and con’s with bioidentical and Synthetic Hormone Replacement therapy
  • Perimenopause: All the basics about perimenopause in one handy guide. What are the causes, symptoms, and natural supplements you can take if you have perimenopause? When does it occur and how long will it last?   
  • Menopause: Get all the basics about menopause in one handy guide. What are the causes, short-term and long-term symptoms, and a natural approach to regulating your hormones?  

 Source: All excerpts from this blog except where noted are condensed and edited from – Dean, C. (2005). Hormone balance: A woman’s guide to restoring health and vitality. Avon, MA: Adams Media.

What are hormones

Hormones are chemical substance and they act as chemical messengers.  Hormones are secreted from the pituitary, thyroid, parathyroids,  pancreas, adrenal,  gonads glands (ovaries for women, testes for men), all of which are part of the endocrine system.  Hormones affect many different systems such as:

  • Your growth and development
  • Your Metabolism – how your body gets energy from the foods you eat
  • Your Sexual function
  • Your Reproduction
  • Your Behavior and Mood

How to hormones get out of balance?

While more emphasis is placed on the gonads, any one of the glands within the endocrine systems interacts in a high-stakes hormonal game and any one of them can cause a hormonal imbalance.  Further, Dr. Carolyn Dean explains that whatever is done by one of the players reverberates through the whole group.  Plus, a tiny amount of change in hormones equates to big changes in cells or even your body.

Hormones of the Reproductive System

Dr. Dean describes the purpose of estrogen, progesterone, and testosterone and the typical symptoms when our hormones become out of balance.

What Estrogen Does?

After we pass puberty and begin menstruating, estrogen’s main function is to stimulate the growth of the uterus, breasts, and ovaries.  WebMD offers the following details about estrogen:

“Estrogen is an entire class of related hormones that includes estriol, estradiol, and estrone.

Estriol is made from the placenta. It’s produced during pregnancy.

Estradiol is the primary sex hormone of childbearing women. It is formed from developing ovarian follicles. Estradiol is responsible for female characteristics and sexual functioning. Also, estradiol is important to women’s bone health. Estradiol contributes to most gynecologic problems, including endometriosis and fibroids and even female cancers.

Estrone is widespread throughout the body. It is the main estrogen present after menopause.” –Source:  http://www.webmd.com/women/guide/normal-testosterone-and-estrogen-levels-in-women

What happens to estrogen levels pre menopause?

Dr. Adrienne Fugh-Berman of the Georgetown University School of Medicine agrees that estrogen levels in the years leading up to the menopause are more often high than low. She cites the variability of estrogen in those years as the reason for perimenopause symptoms. Women can go through their twenties and thirties with no noticeable hormonal symptoms, and then in their forties start having breast tenderness and mood changes, especially around their periods. It’s as if the low estrogen times are lower, with hot flashes at the beginning of the menstrual cycle, and the high estrogen times are higher, causing breast tenderness before the period.

After twenty years of regular cycles that they could set their clocks by, middle-aged women suddenly began to have longer or shorter cycles and more or less bleeding. There was also a group of women who began to develop fibroid and ovarian cysts.  Some of the symptoms were due to estrogen dominance and some were due to progesterone deficiency, which are actually both sides of the same coin.

Hormone Testing

The amount and levels of hormones can vary daily, between night and day, and even from days within a menstrual cycle.  Estrogen and testosterone are secreted in short bursts and can change hour to hour and even minute to minute.  While your doctor can determine whether your health situation and symptoms require a laboratory test to measure hormone levels in your blood, urine, or saliva, you may need to take the test several times to get conclusive results.

Why our choices make estrogen  rise and fall?

Dr. Carolyn Dean offers some of the reasons women have hormonal imbalance from puberty and beyond.

  • Obesity in children and adults: Fat cells are a conversion site for estrogen. Dr. Rose Frisch has been studying body fat and menses for decades. She says that the reason for the earlier onset of menses (for younger girls )is pretty straightforward—it’s all about the fat. In her opinion, the body fat level at the onset of menses has remained relatively constant since 1840. Not many people realize that adipose (fat) cells have the ability to convert precursor hormones into estrogen. What this means for overweight girls, however, is that they will start menstruating early.
  • Dramatic drop in weight once you start your period: Strenuous training for sports or dance can delay puberty by lowering body fat. So, just as 100 pounds is the trigger to start (early) hormonal cycling, once you begin your periods and your weight falls below 100 pounds, your periods can stop. This doesn’t mean that at 99.9 pounds something automatically turns off, but a dramatic drop in weight really can trigger hormonal shutdown. The lack of body fat signals the brain to turn off ovulation. Also, the body needs a certain amount of fat in the form of cholesterol in order to make hormones in the first place.
  • Xenoestrogens and endocrine-disrupting chemicals.  Another culprit of early puberty (and rising estrogen) are cosmetics—especially hair products that actually contain estrogen or placenta. These chemicals include pesticides, herbicides, and insecticides; growth hormones in meat; bovine growth hormone in milk; estrogen-like compounds used by dentists on children; and even the plastic wrap used on sandwiches for school lunches also contribute. The way to decrease the intake of chemicals is to encourage the use of organic food and discourage the use of processed and packaged food.
  • The Birth Control Pill: A woman’s first brush with synthetic hormones usually comes with adolescence. Either because of a desire for sexual intimacy or due to painful or irregular periods, we find ourselves on the birth control pill. Although cramping and painful periods may be due to a deficiency of progesterone and an excess of estrogen, many doctors prescribe the pill (which is usually estrogen-dominant) to alleviate painful symptoms. That’s why some women have intolerable estrogen-induced side effects on the pill—such as weight gain, mood swings, and breast tenderness—even though their painful periods have been effectively suppressed. An anovulatory cycles (a cycle that skips ovulation and goes straight to the period) are most common in puberty and perimenopause. The modern practice of delaying childbirth by suppressing ovulation—sometimes for ten or fifteen years with the BCP—may result in lack of proper synchronization of the hypothalamus and pituitary hormones that direct ovulation.
  • Fertility Drugs: These very strong hormones may have long-term effects that are not yet recognized. For example, I’m hearing from women who have been treated with fertility drugs and are now experiencing extremely early menopause. The fertility drugs on the market are mostly focused on improving one thing—ovulation.
  • Menopause and Perimenopause: Estrogen dominance can occur during perimenopause, when ovulation doesn’t occur and there is little progesterone production in the last two weeks of the cycle. Post-menopausal women who are overweight and who have insulin resistance are candidates for estrogen dominance. Get more information here xxx
  • Surgical Menopause: Tubal ligation or removal of the uterus (hysterectomy) for fibroids, excessive bleeding, or endometriosis is one of the most common surgical procedures in America. In fact, according to a report by Dr. Adrienne Fugh-Berman, one third of women have had a hysterectomy before reaching menopause. Along with removal of the uterus, there often comes the unnecessary amputation of the ovaries. Such sudden elimination of a woman’s major source of estrogen and progesterone sends her into immediate menopause with hot flashes, fatigue, and mood swings.
  • Liver issues: Another cause is when a poorly functioning liver is unable to manufacture the right balance of hormones from good cholesterol. In the movie Super Size Me, within a month of eating a McDonald’s diet the filmmaker’s liver enzymes were completely abnormal and his bad cholesterol and triglycerides were elevated.
  • Food/Diet/Drinking: A diet low in natural fiber can also contribute, as fiber helps bind and excrete excess estrogen. Excessive alcohol use leads to liver damage and hormone imbalance. In one study, blood and urine estrogen levels increased up to 31.9 percent in women who consumed as little as two drinks a day.
  • Stress: Cortisol (the stress hormone) and progesterone compete for common receptors in the cells; cortisol impairs progesterone activity, setting the stage for estrogen dominance.
  • Other: According to WebMD here are some other reasons:

Estrogen levels fall due to: Hypogonadism,  Hypopituitarism, Pregnancy failure (estriol), Perimenopause and menopause (estradiol), Polycystic ovarian , syndrome (PCOS), Drugs that may decrease levels of estrogen include clomiphene. Also, women experience low levels of estrogen immediately after childbirthand also during breastfeeding.

High levels of estrogen due to: “High levels of estrogen are seen in women who have high blood pressure or diabetes. Estrogen levels rise during a healthy pregnancy, and increased estrogen levels may be seen with tumors of the ovaries, testes, or adrenal glands.Some drugs, such as steroid medications, ampicillin, estrogen-containing drugs, phenothiazines, and tetracyclines can increase estrogen levels” http://www.webmd.com/women/guide/normal-testosterone-and-estrogen-levels-in-women?page=2

Hormone and Behavior/Moods (PMS)

According to Marie-Annette Brown, Ph.D., author of When Your Body Gets the Blues, your estrogen and serotonin (the feel-good brain chemical) are both elevated during the first two weeks of your menstrual cycle. Then, in a wicked turn of events, the levels of both estrogen and serotonin plummet about a week before your period, leaving you moody and irritable. Estrogen does appear to be associated with elevated serotonin, but other researchers find that low levels of progesterone are responsible for the PMS mood swings. Either way, the cause is hormone imbalance.

Estrogen also stimulates the nervous system toward an outward focus. This fact has probably got something to do with biology and that primitive urge to seek out a male sperm donor.! It has also been noted that during the second half of the cycle, when estrogen levels are falling, women become more introverted. Again, that may just be biology talking, trying to get us to slow down and get that sperm to take root and hatch a baby. It’s all about the biology!

What about Progesterone?

For most people, estrogen is synonymous with being a woman. Very often the other equally important hormone, progesterone, is left out of the picture. Progesterone is made by the empty follicular sac in the ovary in response to stimulation by luteinizing hormone (LH), and it rises rapidly in the second half of the menstrual cycle. Progesterone is necessary for the “ripening” of the uterus. Estrogen sets the stage by supplying abundant blood supply, and progesterone creates the mucus and brings the nutrients. Along with estriol, higher and higher levels of progesterone are produced during pregnancy in the growing placenta. These high levels of progesterone act as a natural birth control that shuts down monthly ovulation for the duration of the pregnancy. Progesterone is also produced in the adrenal glands and is stored in fat cells.

During the first half of the menstrual cycle, the levels of progesterone are actually quite low. In the second half of the cycle, they surge up to a high level, and they remain there until menstruation occurs. However, progesterone remains low if ovulation fails to occur. There is a name for this type of cycle—anovulatory—and they begin to occur more frequently in women around the age of thirty-five. They also occur in young girls when they first begin their periods and can result in irregular periods and heavy bleeding; for this reason, doctors often prescribe the birth control pills to regulate them.

Anovulatory cycles may be another factor in perimenopausal symptoms. Many people have the impression that estrogen gets lower in the perimenopausal years, but research shows that estrogen actually becomes elevated, whereas progesterone levels fall markedly. And you can see why this is true, if many cycles do not trigger an ovulation and therefore do not produce progesterone. By the time of menopause, when estrogen levels are reduced to half of those of a thirty-year-old woman, progesterone can be approaching zero.

Comparing Estrogen and Progesterone

In the “what goes up must come down” world, the world of yin and yang, the play between opposites, estrogen and progesterone have opposite actions in the body and each is necessary to counterbalance the other.

The main media message about the hormone is that estrogen makes women feminine and fertile. When menopause occurs, estrogen loss is blamed. That’s why it is so hard to convince the public—and many health professionals as well—that many of the health problems in our society may, in fact, be caused by too much estrogen and not enough progesterone.

Hormone Imbalance Symptoms

Estrogen dominance is not defined by a particular amount of estrogen but by having too much estrogen relative to progesterone. Estrogen can be all over the map—low, normal, or high—but if there is little or no progesterone to balance its effects in the body, any amount of estrogen can create estrogen dominance. Thus the blood levels of estrogen can be “within normal limits” and the doctor will tell you “Your blood tests are normal, so everything is all right.” But if he or she doesn’t compare your estrogen levels with your progesterone levels, you might not find out that everything may not be all right.

Researchers say that estrogen is the hormone that makes women alert, focused, and extroverted (mostly in the first half of the cycle), but they neglect to tell us that progesterone creates calm and introversion. It’s this balance in life as well as the balance in hormones that we are lacking. We don’t need a hormone like estrogen to make us race around even more frenetically; we do need more calm and introversion by balancing our lives and hormones with progesterone. Estrogen overstimulation affects all the tissues of the body.

Here are some of the effects of estrogen without the balancing action of progesterone:

  • Decreased sex drive. Progesterone is actually the “sexy hormone.”
  • Irregular periods. Without progesterone you have anovulatory cycles.
  • Heavy periods.
  • Bloating and fluid retention.
  • Breast swelling and tenderness. Estrogen promotes breast tissue growth.
  • Fibrocystic breasts.
  • Headaches (this can be part of the fluid retention).
  • Mood swings.
  • Weight gain in the abdomen and hips.
  • Hair loss.
  • Thyroid abnormalities—cold hands and feet, sluggish metabolism, and fatigue.
  • Foggy thinking and memory loss. While just enough estrogen can make you alert, too much can do the opposite.
  • Fibroids are stimulated by estrogen and resolve at menopause.

Testosterone

Men are as identified with testosterone in the same way that women are with estrogen. But just to spice things up, each sex has a bit of the other’s major hormone. Women make seven times less testosterone than men, and it’s produced equally in the ovaries and adrenals. In men, there is little question about where it’s made, as it all comes from the testicles.

When we see big, muscular men, we tend to think of lots of testosterone. In women, it doesn’t go quite that far; however, studies in women do show that testosterone helps make muscles stronger and bones denser and also gives the sex drive a bit of a lift. Most blood and saliva panels to test for hormones include testosterone; if it is deficient; many women report that using small doses can improve their quality of life.

The reasons for deficiency of testosterone are varied. Total hysterectomy that removes the ovaries along with the uterus cuts the production of testosterone in half. Stress that burns out the adrenals can diminish production in those organs. ERT or HRT can suppress testosterone production in the ovaries by partially shutting down signals from the pituitary. The pituitary thinks there are enough hormones in the blood (even though they are synthetic) and doesn’t push the ovaries to make any more.

What happens when testosterone levels rise or fall?

According to WebMD, women experience a decline in testosterone during menopause. That decline may be correlated to a reduced libido.  High levels of testosterone can also lead to infertility and are commonly seen in polycystic ovarian syndrome (PCOS)- You can find out more here: http://www.webmd.com/women/guide/normal-testosterone-and-estrogen-levels-in-women?page=2

Symptoms of testosterone deficiency include:

  • Muscle weakness
  • General weakness
  • Lack of energy
  • Lowered sex drive

The side effects of too much testosterone replacement therapy include:

  • Acne
  • Facial hair growth
  • Male-pattern baldness

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About Dr. Carolyn Dean – Medical doctor, Naturopath, Herbalist, Acupuncturist, Nutritionist, Lecturer, Author

Dr. Dean has been in the forefront of health issues for over 30 years. She graduated from Dalhousie Medical School in 1978, holds a medical license in California and is a graduate of  The Ontario College of Naturopathic Medicine – now the Canadian College of Naturopathic Medicine (CCNM) in Toronto. She served on the board of Governors of the CCNM for six years. Dr. Dean has authored or coauthored over thirty books, including How To Change Your Life With Magnesium, Future Health Now! Encyclopaedia, Death by Modern Medicine: Seeking Safe Solutions, The Magnesium Miracle, The Yeast Connection and Women’s Health, IBS for DUMMIES, IBS Cookbook for DUMMIES andHormone Balance.  Currently, Dr. Dean lives in Maui with her husband where she visits the beach most days, swims, snorkels and thoroughly enjoys her work and play – most days not knowing which is work and which is play!