Moody, PMS, headaches, night sweats? Consider bio-identical hormone replacement therapy. Listening, understanding, and treating hormonal problems and imbalances is our specialty. Helping our patients achieve hormonal balance is very satisfying. Progesterone and the human estrogen hormones, estrone, estradiol, and estriol, are the primary hormones of all females that need to be in balance. So how do we know which hormone is causing your symptoms?
Listening, understanding and treating your hormonal problems and imbalances can be very tricky and frustrating, but on the other hand, very rewarding when you obtain hormonal harmony. Estrogens, progesterone and testosterone are the primary hormones that need your attention. So here comes the next question. "How in the world do I know which hormone is causing my symptoms?"
This is precisely why all of our patients answer a detailed questionnaire and we take a comprehensive history. Your detailed medical history is unique to you. Therefore, the hormones prescribed will be specific to you according to your age, body size and history. For example, the amount of body fat you have is generally related to the excess of estrogens in your system that same old story of estrogen dominance. This is why some clients may need larger doses of progesterone or testosterone to counteract excess estrogens. We will replace or supplement only the natural hormones that are identical to the same balanced hormones you had as a young adult.
The Three Estrogen Hormones
In females, the ovaries produce the sex hormones; the three estrogen hormones, estrone, estradiol and estriol, progesterone and a small amount of testosterone. When the ovaries begin to function a girl develops her secondary sex characteristics and her menstrual life begins. This is called puberty and usually occurs between the ages of 10 and 15. Menopause is the time when the ovaries cease functioning and the monthly periods stop. The average age of menopause is age 50, with a wide range of variability.
A Woman's Menstrual Cycle
In a perfect world, when a woman has a 28 day menstrual cycle, her ovaries gradually begin to produce increasing amounts of the three human estrogen hormones, estrone, estradiol and estriol, starting on the first day of her menstrual cycle, which is the first day of her period. The estrogen hormones stimulate the growth of the tissue in the inner lining of the uterus, known as the endometrial lining, during the first two weeks of her menstrual cycle. This is termed the proliferative stage because the estrogen hormones are stimulating growth of the endometrial lining. Midway through her menstrual cycle, around day 14, one of her two ovaries will produce an egg. This is called ovulation. The egg lives for one day only. After ovulation the area on the ovary from which the egg is derived will start producing progesterone and a small amount of testosterone.
Progesterone matures the tissue of the inner lining of the uterus, known as the endometrial lining, preparing it for a potential pregnancy. Progesterone means “promoting gestation”, promoting pregnancy. If the egg fails to be fertilized and no pregnancy occurs, then the production of progesterone dramatically falls at the end of the 28 day menstrual cycle and the endometrial lining is sloughed, leading to a period. This cycle repeats itself over and over again during a woman’s menstrual life which extends from the time her periods begin, puberty, until her periods cease at menopause. Progesterone and testosterone, both of which peak at ovulation, stimulate a woman’s desire for sexual relations. The body temperature rises at this time.
Balancing Your Hormones
Female hormonal balance between the estrogen hormones, progesterone, testosterone is essential in order for women to obtain and maintain health and wellness. The three human estrogen hormones have numerous effects on the body which require the balance of progesterone to prevent the hyper effects of estrogen dominance which can lead to a host of health problems. Good health occurs when the hormones in the body are produced in adequate amounts and are in balance. Think of this as hormonal harmony, as if the hormones are a symphony orchestra. If one section of the orchestra, say the brass section, is too loud, then this will drown out the other sections of the orchestra and ruin the symphony.
Human estrogen has the following effects in the body:
• Stimulates growth of the lining of the womb or uterus
• Causes breast tissue to develop and grow
• Promotes fat storage and weight gain
• Promotes fluid retention
• Causes thickening of the blood
• Decreases bone loss, but does not stimulate new bone growth
• Increases emotional sensitivity
• Activates progesterone receptors
• Inhibits sex drive
• Stimulates the production of thyroid binding globulin by the liver, inhibiting the action of the thyroid hormones
Progesterone has the following effects which counterbalance the estrogen hormones:
• Matures the uterine lining preventing excess buildup of tissue
• Inhibits breast tissue overgrowth, preventing fibrocystic breast disease
• Has a diuretic effect which mobilizes fluid, decreasing swelling
• Enhances the action of thyroid hormones, increasing metabolism
• Stimulates the production of new bone, protecting against osteoporosis
• Increases the sex drive
• Protects against breast cancer and uterine cancer
• Thins the blood, preventing blood clots
• Supports the function of the adrenal glands
• Elevates mood
• Promotes pregnancy
As Women Age
A woman’s ovaries generally function best between a few years after puberty until around age 30. As a woman ages so do her ovaries. By the time a woman reaches 35 years of age she is over halfway through her menstrual life and her ovarian function begins to falter. The progesterone hormone production falls most dramatically over the last half of her menstrual life, between the ages of 35 and 50. This decline in progesterone occurs for two reasons. Firstly, the ovaries are aging and functioning less effectively than they did earlier in life. Secondly, as a woman ages she begins to have menstrual cycles during which her ovaries do not ovulate, that is, they do not give off an egg. This is called an anovulatory cycle. When a woman does not ovulate during a menstrual cycle, her ovaries will produce no progesterone. These are the causes of what is termed “progesterone deficiency”. In these cases, the hormones that have the greatest influence in a woman’s body are the estrogen hormones. When this occurs a woman will experience estrogen dominance, meaning her female hormones are imbalanced in favor of the estrogen hormones. Many women have experienced estrogen dominance since puberty. In most women, this condition develops as they move through their menstrual lives.
The Approach of Menopause
The estrogen hormones, progesterone, and testosterone decline as a woman ages. But progesterone declines much more rapidly than do the estrogen hormones. As a woman approaches and enters the change of life, menopause, she may begin to experience the symptoms of declining estrogen hormones manifested by hot flashes and vaginal dryness. By this time progesterone is no longer being produced by the ovaries. Even as she has symptoms of declining estrogen a woman still has estrogen dominance because there is no progesterone to balance the lower levels of estrogen. When a woman enters menopause her ovaries no longer function. Yet, she still makes estrogen hormones, primarily estrone, in her fat cells at approximately 50% of what she made premenstrually.
Estrogen Dominance/Progesterone Deficiency
Depending on the degree of the progesterone deficiency, estrogen dominance may manifest itself with one, some or all of the following effects:
• Premenstrual breast tenderness
• Premenstrual mood swings, irritability, depression
• Premenstrual fluid retention and weight gain
• Premenstrual headaches, including migraines
• Heavier periods often associated with clotting
• Irregular menstrual cycles
• Menstrual cramping
• Fibrocystic breast disease
• Uterine fibroids
• Loss of sexual desires
• Anxiety and panic attacks
• Insomnia and restless sleep
• Bone loss, osteopenia and osteoporosis
• Adrenal gland fatigue
• Autoimmune disorders
• Triggering of allergies associated with more frequent respiratory illnesses
• Urinary frequency
• Easy loss of urine when coughing, laughing or sneezing
• Recurrent bladder infections
• Frequent headaches, including migraines, throughout the month
• Dry eyes
• Increase in body fat
• Sagging skin and wrinkles
• Decreased mental sharpness
• Gall Bladder Disease
• Polycystic Ovaries
• Elevated cholesterol
• Elevated blood pressure
• Breast cancer
• Cancer of the uterus
Many of these symptoms and conditions commonly occur in women of all ages. They may be common, but they are not normal. These symptoms are an indication of declining ovarian function which leads to an inevitable deterioration in health as women age. In order for women to obtain and maintain health and wellness as they age, it is essential that they preserve female hormonal balance as soon as the presence of its symptoms occur.
Not just the uterus, but every cell in a woman’s body has receptors for and is influenced by the estrogen hormones, by progesterone and by testosterone. Most importantly the sex hormones affect the brain, stimulating the production of neurotransmitters, neurochemicals and neurohormones, which enable a woman to think clearly and have elevated moods. When the sex hormones decline, become imbalanced or are no longer produced, brain function deteriorates, manifested by a decrease in mental sharpness, inability to focus, poor short term memory, “brain fog”, mood swings, irritability, depression and anxiety. This is why it is so important to provide women bio-identical progesterone supplementation when indicated for premenstrual symptoms and progesterone replacement after menopause. Although progesterone and estrogen are the two dominant hormones that women produce, it is important to remember that women also produce small doses of testosterone. For women, the production of testosterone peaks at ovulation in order to stimulate a woman’s desire for sexual relations.
Testosterone Effects in Women:
• Relieves panic or anxiety attacks
• Gives a sense of well being
• Decreases body fat and cholesterol
• Increases and enhances libido
• Increases muscle tone (bladder, heart, etc.) and bone mass
• Enhances cognitive thinking and math ability
• Converts inactive thyroid (T4) to active thyroid (T3)
Do You Have Questions? In this age of the information, women are taking charge of their health. They are asking more questions about natural hormones and demanding that their gynecologists offer more than hysterectomies and anti-depressants. We want you to stay educated, healthy and happy on natural hormones, but we need your input. Remember to call with your concerns, questions and symptoms.