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Handling Hormones
You can’t live without ’em – so here’s how to live with ’em
From the mood swings they induce to sleep trouble and bloated bellies, hormones are a woman’s favorite culprit when she’s feeling down and out. But our hormones are responsible for much more than that. They give us our curvy figures, allow us to reproduce, and help us build and maintain strong bones. Gone awry, they can cause problems ranging from excessive hair growth to oily skin.
For females, sex hormones start kicking in as early as 7 years old, and their effects continue throughout a woman’s life. Here’s a look at a woman’s hormonal development through four key stages.
Puberty: The Beginning
What happens. Puberty begins when the ovaries are “turned on” and start pumping out estrogen, says Ronald Strickler, M.D., chair of obstetrics/gynecology and women’s health at Henry Ford Health Systems. This sparks a rapid growth spurt, which includes long-bone growth and muscle mass. Calcium consumption is crucial during puberty, because it’s the peak time for bones to incorporate the mineral, a process aided by estrogen.
Estrogen is what causes breast growth and, about two years into puberty, menstruation. The ovaries also produce a small amount of testosterone, what Strickler calls the “bad actor” in the process – it’s the hormone responsible for oily skin and acne. Meanwhile, the combination of progesterone and estrogen from ovulation gives rise to a feminine body contour – curves, fat deposits on the hips and derriere, increased vaginal lubrication and a final growth spurt.
“The whole idea is to change the body so it’s big enough and strong enough to allow reproduction to occur, and so there’s a frame big enough to carry kids,” says John Randolph, M.D., director of the division of reproductive endocrinology and infertility at the University of Michigan. “It’s a severalyear process, during which time she’s maturing dramatically.”
Strategy. Ensuring puberty proceeds smoothly requires a balanced diet with plenty of calcium, regular moderate exercise and stress management, Randolph says. He recommends that adolescents follow the American Dietetic Association dietary guidelines for children their age.
Girls should avoid meat and dairy that’s been treated with hormones, says John Meulendyk, D.O., a holistic practitioner with the Detroit Medical Center. Hormones are frequently given to animals used for meat and dairy, and their consumption is believed to contribute to premature puberty in girls, he says.
The Reproductive Years: Ages 20-35
What happens. Controlling reproduction is one of the biggest concerns for many women in their 20s and 30s. Estrogen provides vaginal lubrication, but the hormonal roots of a woman’s sex drive are unclear, Randolph says. Testosterone, which begins to decline in women after peaking in the late teens and early 20s, isn’t a major player in helping women get in the mood. “Nobody really knows what hormonally drives women’s sex drive,” Randolph says.
Women in this age group generally have regular cycles, but PMS can become an issue. Marked by bloating, irritability, headaches and other symptoms, PMS tends to increase for women as they get older, especially after having children.
But there’s no direct relationship between hormone levels and PMS, doctors say; a woman with severe symptoms displays no greater hormonal fluctuation than a woman with none. Instead, PMS and its more severe variety, premenstrual dysphoric disorder, appear to be rooted in the brain. “Even though the cycles are the trigger for those who are susceptible to it, no one has been able to show the actual hormones are the issue,” Randolph says.
Strategy. Women with mild to moderate PMS symptoms often benefit from regular exercise, calcium and vitamin B supplements, along with reduced intake of salt, caffeine, alcohol and refined sugar. Women with severe symptoms typically require SSRI antidepressants – the Prozac group – to get relief.
Estrogen continues to aid in calcium absorption, and women achieve peak bone mass around age 30. Getting plenty of exercise, vitamin D and calcium remains crucial.
Late Reproductive Years/Early Menopause: Ages 35-45
What happens. Fertility peaks between 18 and 25 years old, begins to decline after 35 and drops sharply after 40, largely because of the declining quantity and quality of a woman’s eggs. Hormonally, however, women in their late 30s and early 40s aren’t much different than their younger counterparts.
During the late reproductive/perimenopause years, women are most likely to grow fibroids, hormone-fueled growths that can cause heavy periods or pressure on the bladder or rectum. That makes this age the most common time for a hysterectomy, but alternatives exist for some women, including removal of the fibroids themselves.
By the time they reach their mid-40s, women typically develop increasing menstrual irregularity due to the decreased consistency of ovulation. Inconsistent hormone production makes this a “much more disquieting time,” often marked by headaches and moodiness, Strickler says.
Strategy. Natural solutions for these transitional years include plants that mimic sex steroids in the body, such as soy or black cohosh. But Strickler says such approaches must be taken with caution: “Just because it’s natural,” he says, “doesn’t mean it’s safe.”
Meulendyk recommends skipping estrogen in pill or plant form and focusing on meeting the body’s nutritional needs. “If you just treat with hormones, you can miss the underlying cause,” he says.
Meulendyk has recently begun using targeted amino acid therapy on his patients, testing them for amino acid depletion and then giving them the depleted proteins over six to 12 weeks in pill or powder form.
“We’re getting some good results,” he says. “Usually if you deal with nutrition, you don’t need to deal with hormones.”
For those who experience more severe symptoms or want a quicker fix, the birth control pill, which overrides the menstrual cycle, is the common treatment of choice, Strickler says.
The Big “M”: Ages 45 and up
What happens. As women reach their late 40s, estrogen levels continue to fluctuate. Progesterone drops earlier than estrogen, and the decline in both accelerates about a year before a woman’s last period. That drop causes uterine shedding to become irregular and incomplete, leading to longer bleeding episodes, fewer of which are due to ovulation.
“It’s not puberty in reverse, but there are some similarities,” Randolph says. “With menopause, the ovaries run out of eggs. That’s the basic bottom line.”
As the number of eggs decline, estrogen levels sink, beginning about a year before menstruation stops. They continue to drop dramatically until about one year after menstruation ceases.
Reduced estrogen levels are responsible for the symptoms commonly associated with menopause: hot flashes (which affect 70% of women), vaginal dryness, loss of skin elasticity and sleep interruption.
Women begin to lose calcium from their bones as estrogen levels decline, making a bone-mass check important around the time of the last menstrual period.
“The bone is a constantly changing structure,” Strickler says. “It’s absorbing bone and patching with new bone constantly. With the drop in estrogen, absorption becomes faster than patching, and over time, bones thin, which is osteopenia.”
Without estrogen, androgen production no longer is blocked, leading to oily skin and hirsutism (a male pattern of hair distribution in a female) in about 40% of women, Strickler says.
Previous links between estrogen therapy and heart disease have been disproven for women who begin therapy in early menopause, Randolph says. “The current thrust of research is that timing is critical. Starting therapy early so she doesn’t go a long time without estrogen may be helpful, while adding estrogen after a long while doesn’t make sense.”
Strategy. Hot flashes peak about three years after a woman’s last menstrual period. After about six years, all serious symptoms tend to subside, and at 10 years, only about 10% of patients still experience hot flashes. To deal with them, Randolph advises wearing layered clothing, avoiding spicy foods and alcohol, and being aware of sudden changes in your environment’s temperature, which can trigger the shift.
Intercourse can become painful during menopause without estrogen to keep the vagina pliable and lubricated. Estrogen applied locally in a cream or ring can solve the problem.
Women who experience mild to moderate menopausal symptoms benefit most from natural solutions, Randolph says. Those with severe symptoms typically need an SSRI drug or hormone replacement therapy to get relief. There are risks, however – nearly all estrogens increase the risk of blood clotting, which can lead to heart attack and stroke.