Alicia Stanton, MD Blog Posts


All About Hormones

Hormones are natural chemicals that deliver messages to your body’s organs and tissues through the bloodstream. They are made in endocrine glands, which include pituitary, pineal, thymus, thyroid, adrenal glands and pancreas. Additionally, women also produce hormones in their ovaries, and men produce them in their testes.

The way our hormones work is a very integral part of every person’s life. Our hormones are responsible for energy levels, hunger, mood swings, libido, concentration, sleep and many other things that can have a direct affect on our everyday lives.

Hormones are also extremely powerful. It only takes a small amount to result in major changes in a tissue or organ, or even your entire body. Your diet, stress levels and exposure to various toxins can have an adverse affect on your hormones, and subsequently, the way your body operates.

Once it is determined how your specific stress level, diet, toxin exposure, etc. is affecting your hormones and health, Dr. Stanton can begin creating a holistic plan to help balance your hormones and help you maintain a healthier life

Natural hormone balance at any age

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)

Pregnancy Years

“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.

POTENTIAL PROBLEMS

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.”

HORMONE HELP

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

Perimenopause

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.”

POTENTIAL PROBLEMS

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.

HORMONE HELP

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.

Menopause

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.

POTENTIAL PROBLEMS

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.”

The Beginning of the End: Is There an Upside to Perimenopause?

At first I thought my friends and I were simply using perimenopause as an excuse for bitchy attitudes. But the more we experience unusual periods, sporadic cycles, and surprising symptoms, the more it appears that a genuine physiological phenomenon is at play.

After having our babies and heading into our early 40s, we notice that our bodies are changing and that we are going down the long, hot-flash-ridden path to the “change of life,” or menopause.

And it’s a long path. Perimenopause can begin as early as a woman’s mid-30s, and can last anywhere between two to eight years, as our bodies begin to wrap up the reproductive years.

News stories about late-in-life pregnancies, such as Kelly Preston’s, had me thinking that my fertility would stick around for a while. So when I started experiencing hot flashes at night, I thought, “Nah. Not me.”

Now that I’m looking for it, I see perimenopause everywhere (including Sex and the City 2).

We, the formerly fertile women, are now picking up ibuprofen and “super plus” boxes of tampons to deal with abnormal periods, signing up for yoga classes, and ingesting more soy than ever before—anything to alleviate the continued onset of perimenopausal symptoms.

Though perimenopause may seem like a less-than-comfortable transition, I’ve learned several surprising facts, and some nice upsides to this time of life.

Eggs gone bad
Our ovaries start running out of eggs as we age. And as their number decreases, their quality can deteriorate. This deterioration can cause unpredictable cycles for a decade before we can be pronounced menopausal.

“As some of the ‘poorer quality’ eggs start to develop, they may not develop normally and may not be released in ovulation,” says Alicia Stanton, MD, hormone health expert, in Hartford. If this occurs, Dr. Stanton explains, it may upset the hormonal balance, which may result in a skipped cycle and perimenopausal symptoms.

As eggs aren’t released as often, progesterone levels drop, and this can cause estradiol levels to fluctuate, says Dr. Stanton. “This might lead to symptoms of estrogen dominance—heavier menses, bloating, irritability, PMS, breast tenderness, anxiety, hot flashes, heart palpitations and fibroids,” she says.

Because these symptoms can often be confused with other health issues, women may overlook perimenopause as a cause.

However, one poor quality egg isn’t the end. A better quality egg may be released the next month, and the cycle may resume to normal. According to Dr. Stanton, many women “may have (perimenopausal) symptoms off and on for up to 10 years prior to having no menses for an entire year.”

Hormones play a role
In order to alleviate that overwhelming host of symptoms, Kent Holtorf, MD, an expert in natural bioidentical hormone replacement, advises testing your hormones. “Most doctors fail to detect the causative hormonal imbalance because standard blood tests generally miss the hormone imbalance causing the symptoms,” he says.

As mentioned above, low or improper ratios of hormones can cause perimenopausal symptoms, and low-dose birth control pills are sometimes prescribed to addresses this imbalance.

But lower egg quality and hormones aren’t the only factors that could trigger the onset of perimenopausal symptoms. According to Dr. Holtorf, genetic factors, weight gain, insulin resistance, and even environmental toxins, such as plastics and pesticides, can also affect the timing of perimenopause and menopause.

Is our mood really affected?
And what about our bitchy attitudes? Can we pin them on perimenopause? Yes, as it turns out.

“This bitchiness (as well as weight gain and depression) is typically due to a combination of progesterone and thyroid deficiency,” Dr. Holtorf says.

In fact, over 20% of menopausal women in the U.S. are diagnosed with thyroid dysfunction. And it might be worth having these imbalances treated. “When these [deficiencies] are addressed, the overwhelming majority of women will find significant improvement in symptoms,” says Dr. Holtorf.

Whats the good news?
After learning about all these symptoms that could be heading my way, I felt desperate for an “upside” to perimenopause. Dr. Stanton had some reassuring news for me: “It usually signifies a time when a woman can start thinking more about herself.”

She explains that a woman going through perimenopause has fewer responsibilities to others, the wisdom that comes from her 40 to 50 years on the planet, and children who can take care of themselves. “I find that this is the time when women re-evaluate their lives, jobs, and relationships and finally get the strength to do the best for themselves,” she says. And, she adds, because you don’t have to worry about pregnancy once you’re actually menopausal, you can really have fun with sex!

I knew those ladies in Sex and the City were onto something. Perimenopause may be nigh, but I feel prepared, and even intrigued, by this next chapter in our lives.

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