Hormones Resource Center

Menopause and Hormone Balance Issues
article syndicated from ZRT Laboratory

In the years leading up to menopause (perimenopause) menstrual cycles that may once have been like clockwork start to become erratic. Bleeding may be heavier or lighter than usual—although women are not officially in menopause until they have had 12 consecutive months without a period. Erratic cycles are a sign of erratic ovulation leading to highs and lows in estrogen and progesterone, an effect many women describe as an emotional roller coaster.

And don’t let anyone tell you it’s all in your head.

When the ovaries begin to sputter, hormone production sputters and so do we…forgetfulness and foggy thinking, mental confusion and mood swings are hallmark symptoms for many women; as are hot flashes and night sweats, tearfulness, unwanted weight gain, thyroid problems and declining interest in sex, no matter how much we love our partner. Of course not all women experience all these symptoms—as individuals we each have our very own biochemistry—but it is common to experience some degree of discomfort during the menopausal years. And the degree to which we experience discomfort is likely to be associated with the degree to which our hormones are out of balance.

If you are a woman experiencing menopausal symptoms you will want to test at least two hormones: Estradiol and Progesterone. If you would like a more comprehensive picture our five panel test measures: estradiol, progesterone, testosterone, DHEAs and morning cortisol.

Hot Flash and Night Sweats

Is it hot in here or is it just me?? It’s a common refrain among the estimated 50 to 75% of women in the U.S. who experience hot flashes and/or night sweats during menopause. Hot flashes can be very mild, or bad enough to have you opening every window in the house, even in the dead of winter. Also known as “vasomotor flushing,” the hot flash occurs when the blood vessels in the skin of the head and neck open more widely than usual, allowing more blood to shift into the area, creating the heat and redness. Perspiration is also common to the phenomena and in some women the hot flash takes the form of a night sweat, followed by a chill that has one groping for the covers kicked to the floor just minutes earlier.

Night sweats are on a continuum with hot flashes, occurring most often in the wee hours between 3 to 4 a.m., a common cause of sleep disturbance in menopausal women, many of whom say they wake drenched in perspiration. Usually triggered by falling estrogen and rising levels of follicle stimulating hormone, hot flashes arrive unannounced, and usually at a most inconvenient time—in the middle of a job interview, in the middle of an important speech, in the middle of the night. Besides hormonal changes, anxiety and tension magnify hot flashes and many women find that hot drinks and wine do the same.

Saliva testing identifies the degree to which the specific hormones associated with hot flashes are out-of-whack. Using test results as a guideline, lifestyle improvement and natural (bioidentical) hormone supplements can be prescribed as needed to restore balance and cool the hot flashes. Many women also use phyto (plant) estrogens, such as Dong Quai and Black Cohosh; optimal nutrition and relaxation exercises for added relief. In most cases, hot flashes usually go away a year or two after actual menopause and the cessation of menses.

Fatigue and Stress

Many people experience high levels of mental and emotional stress on a regular basis, which puts a significant strain on adrenal function. The adrenal glands are two triangle-shaped glands that sit over the kidneys, and are primarily responsible for governing the body’s adaptations to stress of any kind. When stress becomes excessive or is not well-managed, the ability of the adrenal glands to do their job becomes compromised. The adrenals normally secrete cortisol in response to stress, exercise and excitement, and in reaction to low blood sugar.

The body normally secretes the highest amount of cortisol in the morning to get us going, with levels decreasing throughout the day. People with adrenal imbalance will often have abnormally high or low cortisol levels throughout the day. If stress remains too high, the adrenals are forced to overproduce cortisol continuously. After a prolonged period of time, the adrenals can no longer keep up with demand and total cortisol output plummets leading to adrenal exhaustion.

The hallmark symptoms of adrenal dysfunction are stress and fatigue that is not alleviated with sleep—that tired all the time feeling. Other common symptoms include sleep disturbances and/or insomnia, anxiety, depression, increased susceptibility to infections, reduced tolerance for stress, craving for sweets, allergies, chemical sensitivities and a tendency to feel cold.

Saliva testing charts the extent to which cortisol levels are out of balance and test results can be used as part of a strategy that looks at the whole person and his or her lifestyle. It is helpful to work with a doctor who can design a complete program of hormone balance and then monitor your progress.

You can begin to support adrenal function on your own by avoiding hydrogenated fats, excess caffeine, refined carbohydrates, alcohol, and sugar. Get plenty of quality protein and eat regular meals of high nutritional value.

The key to success is to discover and practice stress management in whatever form works for you personally. Take time out, evaluate the stressors in your life, and find ways of expressing yourself creatively. Get enough rest and sleep. And last but not least, keep a sense of humor!

Low Sex Drive

Estrogen, progesterone and testosterone are key players in the maintenance of circulation, nerve transmission and cell division, so an imbalance of these hormones can easily lead to changes in sexual response. Declining estrogen levels common to the menopausal years can dampen nerve impulses during sex, making us less sensitive to vibration and touch. And since estrogens increase blood flow to sexually sensitive areas, decreased levels can slow or diminish the arousal response.

Imbalances of estrogen and testosterone can cause dryness and thinning of vaginal tissue making intercourse uncomfortable or downright painful—an effect that does absolutely nothing for libido. Key to a normal sex drive is the right balance of estrogen to progesterone. An excess blocks thyroid function which inhibits libido. A balance stabilizes mood and supports thyroid function which enhances libido. Significantly, progesterone is also a precursor to estrogen and testosterone so we need it in steady supply for optimal sexual pleasure.

Testosterone and DHEA also have a major impact on sex drive. Levels gradually decline in the years leading to menopause and can drop dramatically with hysterectomy, chemotherapy, surgery and radiation. If you have a low libido and have lost interest in sex, saliva testing to measure levels of estradiol, progesterone, testosterone and DHEA-s can establish probable cause and a rationale for correcting the imbalance.

PMS

PMS differs from all other disorders because the diagnosis does not depend on the type of symptoms you suffer from, but on the time when your symptoms appear and disappear. Dr. Katharina Dalton of the U.K. a leading specialist who first used the term “premenstrual syndrome” defines it as the presence of recurrent symptoms before menstruation with the complete absence of symptoms after menstruation. Doctors have identified at least 150 symptoms that occur in PMS but fortunately, because all of us are different, no one has all of them! Among the most common are bloating, headache, backaches, severe grouchiness, depression, breast tenderness, loss of libido and fatigue.

Do these symptoms sound familiar? They are also the symptoms of estrogen dominance!

Katharina Dalton knew this back in the late 50s when she pioneered the use of natural (bioidentical) progesterone to balance estrogen in PMS patients, with great success. Over the years she and physicians like Dr. John Lee in this country have treated thousands of women in this way. The great majority of patients report remarkable improvement in their PMS symptoms including the elimination of premenstrual water retention, cramping, tearfulness and weight gain.

This has to do with progesterone’s potent balancing effect upon estrogen. Saliva testing can determine if your PMS is associated with estrogen dominance. Measure your saliva levels of estradiol and progesterone during days 19-21 of your cycle. A low progesterone/estradiol ratio on your test report indicates estrogen dominance and the likelihood of PMS symptoms.

If this is the case, it is worthwhile to talk to your doctor about supplementing with natural progesterone to keep estrogen levels in check. To learn more read: PMS: The Essential Guide to Treatment Options by Dr. Katharina Dalton and What Your Doctor May Not Tell You About PreMenopause, by Dr. John Lee.

All about Natural (Bio-identical) Hormones

Natural or “bioidentical” hormone replacement therapy (BHRT) ise synthesized from natural plant substances to be identical in structure and function to those our bodies produced naturally before menopause. When hormone production starts to drop below normal levels in the years leading up to menopause, natural hormones are the best and safest way for women to supplement. They are available through your doctor by prescription or tailormade to meet individual (physiological) need by a compounding pharmacist. Some natural hormones are available over-the-counter but it is always wise to do research first. Consult Dr. John Lee’s books on premenopause and menopause for an approved list of creams.

Please note: Progesterone – not “progestin” – is the natural bio-identical form of the hormone as opposed to progestin, the synthetic version (the “pro” in Prempro). Natural, progesterone is just like the progesterone your ovaries make and it is available in a topical form over-the counter and by prescription when compounded with natural estrogens and other hormones by compounding pharmacists. When hormone balance is restored and maintained using natural, bioidentical hormones there are far fewer side effects, symptoms and cancers than are observed with synthetic HRT. Following natural physiology as closely as possible makes sense, because in a sense natural hormones have undergone safety trials as long as humans have walked the earth!

What is Progesterone and Why Do We Need It?

Progesterone can be thought of as a hormonal balancer, particularly when it comes to the estrogens. Progesterone is a steroid hormone made by the corpus luteum of the ovary at ovulation, and in smaller amounts by the adrenal glands. It is the precursor, or substance from which most of the other steroid hormones are derived, including cortisol, androstenedione, the estrogens and testosterone. Progesterone has a remarkable repertoire of important jobs from normalizing blood sugar levels and facilitating thyroid hormone action to regulating menstrual cycles and maintaining a healthy pregnancy. The survival of the embryo in the womb absolutely depends on this vital hormone. Progesterone also has natural calming and diuretic properties and it enhances the positive effects of estrogen while preventing the problems associated with estrogen dominance.

Unopposed estrogen (in the absence of adequate progesterone) can build to unsafe tissue levels that lead to a strong risk for breast and reproductive cancers. While estrogen levels drop only 40-60% at menopause progesterone levels may drop to nearly zero in some women, resulting in estrogen dominance and the array of symptoms that go with it. Supplementation of natural, bioidentical progesterone has been shown to restore hormonal balance, especially during perimenopause and menopause.

Osteoporosis

Saliva testing can identify specific imbalances in each of the major hormones that have an impact upon bone health—particularly, testosterone, DHEA, cortisol, estrogen and progesterone. Bone is a hormonally sensitive tissue that is affected by age-related decline in production of these hormones. Many studies show that both men and women as they age begin to lose bone as the androgens—testosterone and DHEA in particular—start to fall off. When these hormones are low and cortisol is high, bone loss increases at an even more rapid pace. We know that too much stress raises cortisol output, interfering with calcium absorption and bone-building activity, while at the same time stepping up the activity of bone destroying cells. We also know that cigarette smoking, alcohol intake and a lack of physical activity are associated with bone loss.

In a typical case study from our files a 63 year-old woman who had never taken hormones since her menopause at age 51 had a bone density scan which revealed osteoporosis in her hip and spine. Saliva testing identified an imbalance of androgens as well as low estrogen and progesterone levels. Supplementing with natural hormones brought noticeable improvement, but to gain full relief, a program of stress reduction, optimal nutrition and weight-bearing exercise was introduced.

Thyroid, Weight Gain and Depression

More than 10 million Americans have been diagnosed with thyroid disease, but interestingly, women are at greatest risk, developing thyroid problems seven times more often than men. Thyroid hormone regulates metabolic rate so low levels tend to cause unwanted weight gain, depression, low energy and cold intolerance. Excess thyroid causes higher energy levels, a feeling of being too warm all the time and weight loss. But it’s hypothyroidism, or low thyroid, that is most common in women during the perimenopausal and postmenopausal years; in fact, some 26% of women in or near menopause are diagnosed with hypothyroidism.

In his book, What Your Doctor May Not Tell You About Menopause, Dr. John Lee discusses how, as he learned more about the condition of estrogen dominance, it became apparent that the taking of thyroid supplements among his women patients was especially common in those with estrogen dominance. This is because when estrogen is not counterbalanced with progesterone, the estrogen buildup blocks thyroid hormone creating a condition of low thyroid. Saliva hormone tests often reveal that women who are estrogen dominant often have menopausal symptoms intertwined with low thyroid symptoms. The most common are weight gain or being unable to lose weight and depression. Cold intolerance, thinning hair, sleep disturbance, fatigue, mood swings and low sex drive are also commonly associated with low thyroid. If you are suffering from these symptoms, estrogen dominance may be a causative factor that can be identified through saliva testing.