By Dr. Baljit Pawa, MD
Many women avoid their own health needs, while diligently caring for the needs of others. But your health matters too. And your hormone health wants your focused attention.
What is hormone health?
Hormones are chemical messengers that regulate numerous aspects of our physiology and function, everything from reproduction to emotion, to general health and well-being.
When hormones are balanced, we feel energized, happy and vital. Many women don’t even think about their hormones until the week before their period or during peri-menopause, when symptoms start to occur.
Often women describe this hormone imbalance as “I just don’t feel like myself anymore.” Maybe they feel more tired than usual, aren’t sleeping as well, having difficulty concentrating, or can’t seem to lose weight.
Women may be more irritable, feel overwhelmed or not in control of themselves, or feel deeper anxiety and depression. Some complain of severe temperature changes resulting in hot flashes and night sweats.
Imbalanced hormones may be an excess or a deficiency of any of the sex steroid hormones, in relation to one another and in relation to the usual healthy levels.
These hormones may include estrogens, progesterone, DHEA, and testosterone, as well as their precursors and byproducts. Changes in other hormones such as thyroid hormones and adrenal hormones may also contribute to hormone imbalances.
Within the clinic where I practice, doctors base their comprehensive treatment plans for hormone health on the results of a comprehensive 24 hour urine hormone panel, which measures all these hormones, as well as how the liver breaks down hormones in the body.
Premenstrual Syndrome (PMS) versus Premenstrual Dysphoric Disorder (PMDD)
Women’s hormone levels change throughout the menstrual cycle. Studies suggest that rising and falling levels of hormones (such as estrogen and progesterone) may influence chemicals in the brain, including a substance called serotonin, which affects mood.
A woman may notice the changes in hormones throughout the menstrual cycle as symptoms of PMS. For instance, they might become teary-eyed and experience some fatigue, irritability or breast tenderness in the week leading to and/or the week of the period.
Up to 75% of women experience PMS at some point in their lives.
When these symptoms are severe, we call it PMDD (Premenstrual Dysphoric Disorder), which is rarer (approximately 5% of women). PMDD is PMS taken to a new level.
After menopause, the ovaries produce substantially less estrogen contributing to the symptoms typically associated with menopause, such as hot flashes or night sweats, low libido, difficulty sleeping, and vaginal dryness.
Mitigating symptoms of hormone imbalance
In addition to stress hormones, the adrenal glands produce sex steroid hormones called DHEA and testosterone.
DHEA is nature’s backup plan once the ovaries’ capacity to produce hormones is diminished, and it is also known as our ‘anti-aging hormone.’
If the adrenal glands are functioning optimally, they can smooth out the hormonal fluctuations and deficiencies that occur during perimenopause and menopause. These women have remarkably fewer symptoms.
However, if our adrenals are taxed (often due to inflammation, chronic stress or poor diet), they are simply not able to smooth out those hormonal changes and women experience more symptoms.
The best way to mitigate symptoms of hormone imbalance, at any stage in life, is to manage stress, exercise and to consume a healthy diet. All of these factors optimize hormone balance.
For a woman struggling with PMDD, symptoms become extreme and noticeable to family, friends and colleagues, and those symptoms may interfere with everyday tasks or enjoyment of life.
It is thought that these women are particularly sensitive to the hormonal changes that occur during their cycle.
The most common symptom is a severe change in mood (aggression, depression, suicidal ideation, rage) that others notice. Women with PMDD often require intervention with medication by a reproductive psychiatrist or hormonal manipulation by hormone specialists.
Perimenopause and menopause
In their mid 30’s and 40’s, women’s ovaries begin to produce less progesterone, often leaving them with a hormonal imbalance in favour of estrogen, which can aggravate symptoms of PMS.
Perimenopausal symptoms might include more irritability and mood swings, bloating, breast tenderness, headaches, and heavy periods or cramping. Symptoms may begin 8-10 years before menopause.
What are non-hormonal treatment options for women?
1. Dietary changes can support hormone health:
• Every woman can benefit from healthy fats (such as avocado, olive oil and coconut) and sufficient fiber in her diet, which provides the building blocks for hormone production and help to eliminate excess hormones from the body.
• Eat a clean diet that avoids pesticides and herbicides, as well as hormones and antibiotics found in conventional meat and dairy. Cruciferous vegetables are helpful for helping to breakdown estrogens.
• Avoid inflammatory foods that tax our adrenals, such as caffeine, alcohol, sugar, dairy and wheat.
• Customized dietary recommendations tailored to your nutritional requirements can also help to regulate blood sugar levels, support healthy thyroid function, manage weight and support colon function, all of which help to balance hormones.
2. Specific natural supplements may also be part of a hormone health management plan:
Individualized nutrient supplementation can reverse nutrient deficiency, while nutraceuticals and herbs can be used to support thyroid and adrenal function and help to maintain healthy cortisol levels.
Many women are deficient in Omega-3 essential fatty acids, magnesium and Vitamin D, and may benefit from supplementation of these nutrients.
3. Lifestyle plays a huge role in our hormone health, particularly with respect to managing stress:
The importance of regular exercise, adequate sleep, and a daily mindfulness practice for balanced hormones cannot be overstated.
Our health coaches support our patients to incorporate dietary changes, exercise and mindfulness practices into their everyday routine in a way that works for them.
Hormone treatment options
In addition to dietary and lifestyle changes and natural supplementation, hormone therapy may be used to rebalance hormones and optimize health.
Most hormones used currently are derived from plants, are molecularly equivalent to human hormones and used in low doses. This may include cyclical or continuous use of progesterone, estrogen, and other sex hormones.
In addition to relief of short-term symptoms, some bio identical hormones provide long term benefit for heart, brain and bone health, particularly if used soon after menopause.
Although bioidentical hormones are often natural and can be beneficial for most, they still carry risk for some women, especially if they have breast cancer or are prone to blood clots.
Consult with your health care practitioner about conducting a customized risk assessment before initiating hormone therapy. Once on hormone therapy, it is important to be monitored and to have regular check-ups.
Symptoms of hormone imbalance can be variable and come on gradually. Some women have come to believe that they are a normal part of aging.
Actually, these symptoms are our body’s way of telling us that something is out-of-balance and needs our attention. Quality of life is important and hormone therapy helps provide relief of symptoms and also protection from some chronic diseases.
It is true that women outlive men, but we do not have the same quality of life as men due to our hormone disadvantage.
The World Health Organization recently released a compelling paper indicating that women are going to be facing an epidemic of chronic disease. Most nursing homes are filled with women who have dementia or fractures due to osteoporosis. Hormone therapy is one way to help close this gender gap in health.
Women tend to put others’ needs before their own health, and as we age we start to suffer from this lack of self-care during our lifetime. Perimenopause and menopause is a window of opportunity where we can learn to put ourselves first and to focus on our own needs.
Since women support so many people around them, nothing is more important than their own health. —LP