Health in Balance
Sharon Norling, MD, MBA
“While imbalances in sex hormones create many symptoms in the peri-menopausal and menopausal woman,
these symptoms can also stem from adrenal, neurotransmitter, and thyroid imbalances.”
Hormones. Most women think of “hormones” as estrogen, progesterone andsometimes testosterone. Throughout a woman’s lifetime they experience the fluctuating hormones and attribute mood swings, hot flashes, cravings, anxiety, depression, fatigue, joint pain, weight gain, low libido, mental confusion or memory loss and insomnia to the imbalance of female hormones. Frequently, this is only one piece of the puzzle. Our bodies are complex. How we feel and respond involve the interaction and integration of the endocrine, immune, enteric and nervous systems. Neurotransmitters carry messages to every organ, muscle and gland. Poor nutrition, drugs, heavy metal toxicity and over stimulation deplete and imbalance the neurotransmitters which impairs the function of all systems. Thus, the balancing of these systems is a delicate dance, and one that requires a great deal of experience and information.
The Women’s Health Initiative (WHI), set out to definitely answer questions about the risks and benefits of hormone replacement therapy (HRT), but only added to the confusion and concern. First, it studied only synthetic hormones (Premarin and PremPro), given orally in a fixed dose. Secondly, the study chose older participants; the mean age was 63.2, allowing females up to 79 years of age. This age group generally has greater health risks and is not using HRT. Also included were women who were overweight, had hyperlipidemia, subclinical atherosclerosis, and 49.9% were smokers.
Interestingly enough, the study actually excluded women with hot flashes, a major symptom of menopause.1 Based on misconceptions and misinformation, sensational reports of WHI findings indicted HRT for causing breast cancer and heart disease.
A secondary review of the WHI’s findings separated the estrogen and estrogen-progestin arm into the 50-59 year olds, the age when women generally use hormonal replacement therapy. In the estrogen-progestin arm the CHD hazard risk ratio was found to be 0.76. A risk ratio of less than 1 is indicative of less risk of disease. In the estrogen only arm there was 23 % less invasive breast cancer than in the placebo group.2 Another study found that administration of trans-dermal estrogen diminishes the largest adverse hormone-event: thromboembolism.3 Based on the results of these studies, further research is needed to identify the risks and benefits of HRT and bio-identical hormone use in appropriate age groups.
In addition to the questions regarding the risks and benefits of female hormones, women present with multiple symptoms which may or may not be due to these hormones. Often, when a woman experiences premenstrual syndrome (PMS ) , peri-menopause or menopause, conventionally they are prescribed female hormones. When this is not effective or symptoms remain, the hormones are changed or the dose is increased. Looking at only one hormone system, however, is not adequate. Successful treatment of women requires proper diagnosis and treatment of adrenal function. When adrenals are stressed, estradiol and testosterone can be shunted to DHEA while progesterone goes to cortisol. In women, the adrenal glands are the only source of DHEA. In the menopausal female, the adrenals are the only source of testosterone and the ovaries produce estrogen and progesterone at a much lower rate. If the adrenals are exhausted and cortisol is low, menopausal and PMS symptoms intensify. Therefore, adrenal normalization should precede hormone modulation. Neurotransmitter evaluation and support is also important. The inhibitory neurotransmitters, serotonin and GABA help to maintain calm and mood in the body, while the excitatory system, the dopamine, norepinephrine (NE), epinephrine (EPI) and glutamate, influence energy, focus, and memory. While imbalances in sex hormones create many symptoms in the peri-menopausal and menopausal woman, these symptoms can also stem from adrenal, neurotransmitter, and thyroid imbalances.
The dancing hormones and their interactions are responding not only to each other but are modulated by our lifestyles and significantly impacted by stress. The complicated balance of our hormones and our brain chemistry challenges our stress adaptation mechanisms, and fatigue can result. These fluctuating levels in hormones such as estrogen, progesterone, testosterone, cortisol and thyroid, interact with brain neurotransmitters that affect our emotional and physical responses to life, stressors in our environment, insults, and even infections.