As women age, hormones have many opportunities shift out of balance. This guide offers an explanation for what affects hormones and how to regain balance during pregnancy, perimenopause, and menopause.
It’s not just puberty and menopause: Women experience hormonal changes throughout their lives. New research shows the onset of menopausal symptoms is often linked to the modern Western lifestyle, including nutrient-poor diets of refined foods, alcohol consumption, smoking, chronic stress, depression, lack of exercise, and exposure to endocrine-disrupting toxins found in common household products.
The good news about symptoms is that “women get a wake-up call,” says Marcelle Pick, RNC, MSN, a Yarmouth, Maine–based ob-gyn nurse practitioner. “When the body is out of balance, it really screams at them. Men have heart attacks. Women have an opportunity to get really healthy.” Making smart lifestyle changes—especially before peak transition times—can help smooth out symptoms, says Alicia Stanton, MD, an Enfield, Connecticut–based integrative physician and coauthor of Hormone Harmony (Healthy Life, 2009)
“Hormones tend to be more stable when women are in their 20s and 30s, unless they have a boatload of stress,” says Pick, who co-founded Women to Women, an integrative clinic that serves women both online and in person. Ordinarily, estrogen is high in the first half of your cycle; in the second half, estrogen comes down and progesterone goes up. Then they both plunge right before your period.
But many women—Stanton estimates as many as 80 percent—have a condition known as estrogen dominance, an imbalance believed to be triggered partly by excess body fat, poor diet, stress, and exposure to estrogenic factors in the environment, such as those leached from most plastics. “Either there’s too much estrogen in the system or not enough progesterone to balance the estrogen,” says Jennifer Johnson, ND, clinical faculty member at the University of Bridgeport College of Naturopathic Medicine.
PMS. Johnson says symptoms during the pre-period hormone drop may be worse for women with estrogen dominance. Common symptoms include headaches, breast tenderness, irritability, depression, bloating, and cravings.
Infertility. If you’ve ruled out structural problems (such as blocked fallopian tubes)—as well as issues with your male partner—and still can’t get pregnant, you may have low progesterone levels in the second half of your cycle.
Cysts or fibroids. “Estrogen is the proliferative hormone,” explains Erin Lommen, ND, a practitioner based in Clackamas, Oregon, and author of Slim, Sane, and Sexy (Fountain of Youth, 2009). That means it helps grow the uterine lining to prepare for pregnancy, but it also grows cysts, fibroids, and cancers. “Progesterone is the antiestrogen, or the balancer.”
Try a natural progesterone cream. You can pick this up without a prescription, but first be sure your progesterone levels really are low. Your doctor can do a saliva or urine test to find out. Look for a low-dose (2 percent) topical cream and check the ingredient list for USP progesterone rather than wild yam, which the body cannot metabolize into progesterone. Apply about ¼ teaspoon (providing 20 mg of progesterone) to the neck, face, chest, or inner arms; rotate the application site daily. Bio-identical progesterone is safe for women when used as directed, says Pick, but a health care provider should monitor any woman using hormones. Women with breast cancer or a history of breast cancer should not use progesterone cream.
Try supplements. Clamp down on crankiness with a B-complex that has at least 50 mg of B6. Take 500 mg per day of krill oil, or 2,000–3,000 mg of high-quality fish oil each day, with meals, to reduce inflammation and cortisol demand. Johnson also suggests evening primrose oil, 1,200–1,500 mg per day with meals, to ease cramps and help with other estrogen-dominance symptoms. Dandelion (both root and leaf)—100–200 mg, or 1/2 teaspoon of tincture, or two or three cups of tea daily—minimizes bloating and helps the liver eliminate excess hormones; it may not be safe for people on diuretics, Johnson cautions. For fertility issues, try vitex, or chasteberry, 300–400 mg daily unless you are already taking prescribed fertility hormones or are undergoing in vitro fertilization, she says.
Avoid environmental and dietary estrogen sources. These include many plastic water bottles; canned foods with BPA in the lining; personal care products with potentially hormone-disrupting chemicals, such as parabens, phthalates, triclosan, and many fragrances; and nonorganic
WHAT YOUR HORMONES ARE DOING
About ten years before menopause, your egg quality declines and your hormones begin to shift—estrogen diminishes a little, and progesterone plummets. “Everyone thinks perimenopause is due to low estrogen, but it’s low progesterone very early on,” says Stanton. “It’s not until the end that you get to the low estrogen.”
Brain fog. Researchers suspect lower estrogen may be partly to blame for the trouble some perimenopausal women report with memory and decision-making, but the stress of busy daily lives makes it worse, Pick says. Chronic stress can lead to adrenal fatigue, a collection of symptoms remarkably similar to perimenopause: insomnia, headaches, fatigue, anxiety, inability to concentrate, and depression. Research also suggests chronically elevated cortisol levels may decrease memory performance.
Low Progesterone and Weight gain. Yep, stress can make you fat. Cortisol releases sugar into the bloodstream to provide fuel during stressful times, and insulin mops up the excess. With too much sugar to process, the body becomes insulin resistant, and converts the excess to belly fat, or visceral fat, which is linked to greater risk for heart disease and other serious health problems. “Visceral fat is harder to lose,” Lommen says. And for many people, turning to refined-carb “comfort foods” when stressed worsens the cycle.
Sleep problems and hot flashes. Perimenopausal women may have trouble falling or staying asleep, possibly due to low progesterone, high cortisol demands, or a disturbance in melatonin, the hormone that helps regulate sleep-wake cycles. Erratic estrogen levels cause hot flashes, says Pick.
Perimenopause and Frequent Periods: Changes in menstrual patterns is common during perimenopause, these changes include, changes in cycle length, and frequency, increased or decreased menstrual flow, and worsening PMS symptoms.
Low Estrogen and Progesterone During Perimenopause: At midlife, most women’s horomones will fluctuate, this can cause hot flashes, night sweats, headaches, insomnia and fatigue.
Eat right, sleep, and meditate. This will keep cortisol and insulin levels stable, and your weight down. Choose low-glycemic foods like lean proteins and complex carbs, which break down more slowly in the body. Sleep seven hours a night to stabilize cortisol levels and balance appetite hormones leptin and ghrelin. A new study published in Menopause found that women who participated in a mindfulness-based stress-reduction program, which included meditating and mindful stretching, had fewer, less-intense hot flashes, better sleep quality, and less anxiety and perceived stress.
Consider bio-identical hormones. They’re the exact same structure as the hormones you make,” unlike the hormones used in the now-infamous Women’s Health Initiative study, Stanton says. (See “Is Hormone Replacement Safe?,” TKwhere.) Nevertheless, the decision to use bio-identicals remains controversial. “They haven’t been studied to the same degree that synthetic hormones have,” Johnson says. “But I see women having fewer problems adjusting to being on them, and fewer side effects than with synthetic hormones.” Women who have a personal or family history of breast cancer, blood clots, stroke, or heart disease should discuss risks with their physicians. Finally, if you know for certain your progesterone levels are low, a natural progesterone cream also may improve symptoms.
WHAT YOUR HORMONES ARE DOING
Menopause occurs when you haven’t had your period for a year. At this point, you really start to lose estrogen. “Estrogen is anti-inflammatory, so when it begins to decline, some people have huge problems with joints. Others have hot flashes; some can’t sleep; some are very anxious,” Pick says. Research shows that estrogen may also protect the heart, brain, bones, and more.
Bone loss. Lower levels of estrogen, progesterone, and testosterone contribute to a more rapid loss in bone mass, Stanton says.
Risk for heart disease, Alzheimer’s, and certain cancers. “Hormones are the messengers in our body,” Stanton says. “They send messages between the brain, glands, and organs, and regulate inflammation. Every imbalance in hormones creates an imbalance in the body.”
HOW TO FEEL YOUR BEST
Take vitamin D. Take 2,000 IU daily for bone health, along with calcium (1,200–1,500 mg total daily from diet and supplements), and 400–600 mg magnesium; take all with food. For best absorption, split calcium into 500-mg doses, taking the last dose in the evening with magnesium, reducing the magnesium dose if loose stools result. “Vitamin D is very anti-inflammatory,” says Stanton. Ideally, get your D levels tested in spring and fall, and aim for a result between 30 and 50, Pick says.
Keep active. Do weight-bearing exercise, like standing on one leg—really. It puts pressure on hips, which lose bone mass easily, Johnson says. In one study of postmenopausal women, physical exercise also reduced menopausal symptoms and significantly enhanced quality of life, independent of whether participants were taking hormone therapy.
And what about the years after menopause? “We keep making hormones, we just aren’t cycling them [monthly for possible pregnancy],” Stanton says. “So the women who have sailed through menopause have stable, low levels of hormones,” though a major stressor can trigger an imbalance. To avoid a return to imbalance, Pick says, “continue to have joy in life, and keep taking steps toward vitality.”