Menopause and Hormones 101

If you’re experiencing symptoms of menopause, you are probably wondering about hormones. Everyone is talking about hormones these days. So here’s a quick crash course in the ones that affect your body.

Let’s start with the three estrogens.

1. Estradiol: Estradiol is produced primarily in the ovaries and is the most potent of the 3 estrogens. This estrogen will decrease significantly during menopause or after removal of ovaries. This estrogen is responsible for the symptoms that most associate with menopause.
2. Estrone: Estrone is produced primarily from fat tissue and muscles. This estrogen is the second most potent. It will be elevated in women who are overweight and has been linked to the accelerated growth of breast cancer among other things. In fact, this hormone is best left out of hormone replacement regimens.
3. Estriol: Estriol is the weakest of the 3 estrogens. It is dominate during pregnancy and has been linked to breast cancer protection.

There are several other hormones that you’ll hear about.

• Progesterone: Progesterone is the counterpart to estrogen. Where estrogen promotes growth, progesterone promotes maturation or stabilization. Progesterone is dominant in the latter half of the menstrual cycle. Progesterone has been shown to have PMS, anti-depressant and anti-anxiety benefits. Simply put, progesterone balances estrogen.
• Testosterone: Yes! Women have testosterone too. It is produced primarily from the ovaries before menopause. After menopause, it is primarily produced by the adrenal glands. Testosterone has well known libido benefits.
• T4: This thyroid hormone is produced in the thyroid gland and released for circulation. It can be replaced with such medicines as synthroid and levothryoxine. Low T4 can be a result of iodine deficient diets.
• T3: This is the most potent of the two thyroid hormones and is produced from the conversion of T4 in the liver and kidneys. T3 is present in the medicines armour thyroid and cytomel.
• Cortisol: Produced in the adrenal glands, cortisol is released in large response to stress. High cortisol levels promote slow metabolism and fat storage. Prolonged stress and high cortisol levels, can result in adrenal exhaustion and low cortisol levels. Low cortisol levels cause fatigue and other symptoms that can mimic depression.

ZRT Laboratory has an interactive graphic that is very helpful in giving you an overview of most hormones your body produces.

My doctor said I have HPV, human papilloma virus.

So you’re probably wondering, “What is the human papilloma virus?”

The human papilloma virus, known as HPV, is the known causative agent in genital warts and abnormal pap smears.

There are many different types of the HPV. Types 6 and 8 cause genital warts. The other types of HPV, particularly 16 and 18, are known to cause abnormal pap smears and 70% of cervical cancers. HPV also has been linked to 35-50% of vulvar and vaginal cancers.

HPV is sexually transmitted. A new HPV vaccine is available for women 9-26 years of age for the prevention of diseases related to types 6, 11, 16, and 18.

Unfortunately, the vaccine is not effective for active disease.

What is Adrenal Fatigue?

Adrenal fatigue is a collection of signs and symptoms, which are a result of sub-optimal adrenal function. Basically, your adrenal glands get tired. The adrenal glands are small organs that sit directly on top of the kidneys.

Adrenal fatigue is caused by acute and/or chronic stress. This stress can be physical, emotional, psychological, or infectious. This stress results in adrenal over-stimulation. If your adrenal glands are under severe stress or prolonged stress, you will likely experience adrenal fatigue. This means that your adrenal gland loses the ability to adequately respond to further stress. It continues to function, but not at an adequate level.

When your adrenal glands get tired, you get tired. The predominate symptom is fatigue. This fatigue can be present for the entire day or wax/wane throughout the day. Other commonly expressed symptoms include:

• fatigue in the morning upon awakening
• feeling run down throughout the day
• difficulty in getting going in the morning
• inability to bounce back from stress
• salt/sweet cravings
• fatigue unrelieved by sleep
• increased effort to do every day tasks
• decreased libido
• decreased ability to handle stress
• increased time to recover from illness, injury, or trauma
• light-headed when standing up quickly
• mild depression
• increased PMS symptoms
• poor focus
• poor memory
• decreased tolerance
• decreased productivity

Most Americans will have some adrenal fatigue throughout their lives. Adrenal fatigue can be a mere nuisance and last from a few days to a few weeks. However, some bouts of adrenal fatigue can be severely debilitating and last for years. We test for adrenal fatigue with a four point saliva test throughout the day.

Your treatment will depend on the degree of adrenal fatigue. We’ll manage mild adrenal fatigue with adrenal rebuilder: an adrenal rich supplement. Adrenal rebuilder provides the building blocks necessary for improved adrenal health and function. Most treatments will last at least 3-6 months, with the more severe episodes of adrenal fatigue taking 6-12 months of treatment.

But don’t worry! With adequate time and treatment, nearly everyone can achieve a full recovery from adrenal fatigue. In fact, with cortisol replacement, most women will experience some improvement within 2 weeks. As your symptoms improve, it is important that you continue the treatment. Rebound adrenal fatigue is a common problem when people stop their treatment too soon.

Patients of Dr. Nathan Goodyear can start an adrenal evaluation by filling out the adrenal fatigue questionnaire. Then, call the nearest Seasons office and set up an appointment to discuss further treatment.

What is Metabolic Syndrome?

Metabolic syndrome is a collection of conditions that occur together to increase a women’s risk of heart disease, peripheral vascular disease, stroke, and type II diabetes.

It isn’t a disease, so much as a collection of conditions. However, it can still be dangerous if left untreated, possibly leading to the diseases listed above: peripheral vascular disease, heart disease, stroke, and type II diabetes.

The identification of metabolic syndrome provides a window of opportunity for treatment to prevent disease.

The following risk factors co-exist in metabolic syndrome…

• abdominal obesity
• blood fat and cholesterol disorders
• elevated blood pressures
• insulin resistance
• pro-blood clot state
• pro-inflammatory state

Abdominal obesity and insulin resistance are the dominant risk factors. Other conditions that affect metabolic syndrome include physical inactivity, aging, hormonal imbalances, and genetic predisposition.

Since it isn’t a disease, we diagnose metabolic syndrome by looking for co-existing symptoms. Any three of the following are required to meet the classification of metabolic syndrome…

• abdominal obesity (waist circumference >35 inches)
• elevated triglycerides (>150)
• low HDL (<50)
• elevated blood pressure (> 130/85)
• elevated fasting glucose (>110)

Metabolic Syndrome is not uncommon. It is estimated that over 50 million Americans have it. We treat it by managing a patient’s weight loss, increasing physical activity, treating hypertension, prescribing daily aspirin therapy to reduce pro-blood clot states, and treating elevated triglycerides and/or low HDL levels.

What symptoms indicate hormone imbalance?

The symptoms of low estrogen include…

• hot flashes
• night sweats
• vaginal dryness
• urinary frequency
• depressed feeling
• sleeping difficulty
• no interest in sex
• no periods

The symptoms of low testosterone include…

• fatigue
• lack of drive
• lack of initiative
• less assertive
• decline in sense of well being
• general depressed moods
• irritable
• lack of self-confidence
• difficulty in setting goals
• decline in mental sharpness
• no stamina/endurance
• loss of muscle mass, strength, or tone
• increased body fat around waist
• elevated cholesterol
• decreased libido
• decreased sexual ability
• sleep apnea

The symptoms of low thyroid include…

• general fatigue or afternoon fatigue
• elevated cholesterol
• difficulty losing weight
• cold hands and feet
• sensitivity to cold
• difficulty thinking clearly
• difficulty concentrating
• poor short term memory
• depressed moods
• hair loss
• constipation
• dry, itchy skin
• fluid retention
• recurrent headaches
• restless sleep
• tingling or numbness in hands and feet
• decreased sweating
• infertility or recurrent miscarriages
• recurrent infections
• muscles aches
• joint pain
• thinning of eyebrows and eyelashes
• enlargement of tongue and teeth indentations
• decreased body hair
• hoarse voice
• slow heart rate
• low blood pressure
• low body temperature
• sleep apnea

The symptoms of high estrogen/low progesterone include…

• premenstrual breast tenderness
• premenstrual mood swings
• premenstrual fluid retention and/or weight gain
• migraine headaches
• severe menstrual cramps
• heavy periods with clotting
• irregular menstrual cycles
• uterine fibroids
• fibrocystic breasts
• endometriosis
• history of infertility
• history of miscarriages
• joint pain
• muscle pain
• decreased libido
• anxiety and/or panic attacks

The advantages of saliva testing

From the patient’s perspective, saliva testing is painless and costs less than conventional blood tests. It can also be collected at home.

From the doctor’s perspective, saliva testing is easier because samples remain stable at room temperature up to 3 weeks. Most important though, saliva testing evaluates the active hormone levels in your body.

After you have collected your saliva samples and mailed them off, DiagnosTechs laboratory will e-mail the results to our office in 5-7 business days.

In a follow-up appointment, we will go over the results with you and discuss a treatment plan unique to your individual needs. Most patients begin implementing this plan at the end of the follow-up appointment.

Further testing will be based on symptoms unique to each individual. Sometimes it is necessary to do additional testing of your thyroid, insulin levels, glucose levels, and cortisol levels.

You can learn more about salivary testing at www.salivatest.com.

Did you say saliva testing?

We use saliva testing to measure hormone levels at our Seasons offices. Naturally, the phrase “saliva testing” raises a few questions.

How do we collect your saliva? We don’t. You do it at home with saliva collecting kits. It isn’t a difficult process, but you do need to follow the directions carefully:

1. 30 minutes before collection, please do no eat or drink anything except water.
2. Rinse mouth thouroughly with cold water 3-4 minutes prior to saliva collection.
3. Following the collection schedule below, collect saliva in each of the 4 blue cap tubes to fill three quarters or more, excluding any foam. Take your time. Recap tubes and place into the zip lock bag.

Morning/Fasting 7 - 8 AM
Noon 11 - 1 PM
Afternoon 4 - 5 PM
Midnight 11 - 12 PM

Each saliva collection kit includes some “pour off tubes.” Here’s how they work.

Pour off enough saliva from the noon and/or afternoon tubes to fill 1/4 of the tubes labeled FL and FT3. Cap tubes tightly. Follow the mailing instructions. If you pour more, do not pour saliva back into the blue cap tubes.

Finally, on the day you are collecting saliva, there are a few things you want to avoid.

• Do Not Eat chocolate, onions, garlic, cabbage, cauliflower/broccoli.
• Do Not Drink coffee, tea, or caffeinated drinks (like coke, guarana, etc.)
• Do Not Use sublingual hormones or troches as of the night before collection.
• Avoid antacids, bismuth medications or mouth washes.
• Stop your current hormone therapy 72 hours prior to the saliva collection.

What hormones will I need and how do I take them?

Bio-identical hormones are available in creams, ointments, sub-lingual drops, vaginal suppositories, pills, and injections. So you have a lot of options on how you can take them.

As to what hormones you will need, this will depend on the individual. Your hormone needs are as unique as your fingerprints. A one size fits all approach is not appropriate in hormone therapy. Therapy will be specifiic to your hormone deficiency.

We use salivary testing from DiagnosTechs Laboratory to determine what hormones you need. Over 300 studies have been published validating the accuracy of hormone salivary testing.

Once we’ve determined what hormones you need, bio-identical hormone therapy draws upon 6 type of hormones:

• Estrogens
• Progesterone
• Testosterone
• DHEA
• Cortisol
• Thyroid

You can read more about the different types of hormones in my post “Menopause and Hormones 101.”

What are bioidentical hormones?

One of the most frequent questions we here is: “Hey! What is the difference between bioidentical hormones and synthetic hormones like premarin, prempro, premphase, and provera?”

I’m glad you asked! Synthetic hormones include conjugated equine (that’s horse in English) estrogens and progestins. (My wife is not a horse, and I’m pretty sure you aren’t either!)

The key difference between bioidentical and synthetic hormones is molecular structure. In an effort to fully replicate the function of the hormones produced by your body and to minimize the side effects, the molecular structure of the hormones must be identical to those produced in your body.

Synthetic hormones are similar but not identical. These structural differences lead to metabolism by-products that increase the frequency and intensity of unwanted side effects.

Bioidentical hormones are structurally and chemically identical to the hormones your body produces.

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You may have heard that there are not many studies about bioidentical hormones. Certainly, there have not been as many studies of bioidentical hormones as synthetic hormones. But, here’s why.

Pharmaceutical companies fund research for synthetic hormones through profitable patents and mass production. Bioidentical hormones cannot be patented, and thus there are limited funds for research. There are some European studies of bioidentical hormones, but they are small in number and limited in scope.

Related articles by Zemanta and Seasons

• Bioidentical hormones: What does the scientific evidence say?
• The Bioidentical Hormone Debate (www.postgradmed.com)
• Abstract: Are Bioidentical Hormones (Estradiol, Estriol, and Progesterone) Safer or More Efficacious than Commonly Used Synthetic Versions in Hormone Replacement Therapy? (holtorfmed.com)
• Study: Hormone therapy caused breast cancer for thousands (cnn.com)

What are common symptoms of menopause?

The most common symptoms include

• hot flashes
• night sweats
• insomnia
• vaginal dryness
• mood swings

By definition, menopause is one year without a period. On average, women reach menopause when they are 51. However, many women experience symptoms before menopause, sometimes even in their thirties.

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