Bioidentical Hormones For Women’s Health
Bio-identical Hormone replacement therapy (BHRT) replaces hormones that their ovaries stop making. The ovaries make estrogen and progesterone as part of the menstrual cycle. The ovaries also make androgens, including testosterone. Hormone levels usually start to change during perimenopause, the years just before menopause. In perimenopause, many women begin to have symptoms such as hot flashes, vaginal dryness, irregular periods, and insomnia. The reason for the symptoms is usually fluctuating and declining hormone levels.
These hormonal changes are due to aging ovaries that are losing their ability to produce eggs and hormones. Women may have widely varying estrogen levels during their monthly cycles as the ovaries keep trying to produce eggs. Often, there will be cycles in which no ovulation occurs, called anovulatory cycles, and no progesterone is produced. This can lead to irregular cycles with heavy or abnormal bleeding as a woman approaches menopause.
At menopause, the ovaries stop producing and releasing eggs or ovulating each month, and monthly periods stop completely. The ovaries are no longer producing estradiol and progesterone, although they continue to produce androgens. Menopause does not mean, however, that women have no estrogen in their bodies anymore. Women with more body fat usually have more estrogen than thinner women do, because estrogen is aromatized in fatty tissue.
After menopause, there is much less estrogen and testosterone in the body than before menopause, and very little progesterone. This drop in hormone levels can have various effects, including the familiar symptoms of menopause such as hot flashes, night sweats, vaginal dryness, and loss of libido.
A woman who has a surgical menopause, in which her ovaries are removed, usually along with her uterus and fallopian tubes, will have a much more sudden drop in all sex hormone levels than a woman going through natural menopause. This sudden loss of hormones can cause severe symptoms and health problems, especially in younger women, unless adequate hormone replacement is provided.
Women must have adequate levels of important hormones needed for keeping the body in balance, and these hormones are progesterone, estrogen, testosterone, and thyroid hormone.
Progesterone is one of the 2 main female hormones, the other being estrogen, produced each month by the ovaries of menstruating women, and it is produced in smaller amounts by the adrenals. It is the major female reproductive hormone during the latter 2 weeks of the menstrual cycle, made by the corpus luteum of the ovary. It is normal for the levels of progesterone to rise and fall during the monthly cycle. Progesterone production starts just before ovulation each month and increases rapidly after ovulation. It is what enables the fertilized egg to survive.
During the first 2 weeks of a normal menstrual cycle, estrogen is the dominant hormone. In response to ovulation around day 14 of the cycle, estrogen levels drop and progesterone levels rise and assume dominance for the final two weeks of the month. When progesterone levels drop the next menstrual cycle begins in about 48 hours. During Perimenopaue and menopause, progesterone can become deficient, which can disrupt the many functions of progesterone. Some of the functions that progesterone helps to maintain include:
- Helping use fat for energy
- Facilitating thyroid hormone action
- Natural antidepressant
- Natural diuretic
- Normalizing blood sugar levels
- Restoring proper cell oxygen levels
- Helping restore libido
- Normalizing zinc & copper levels
- Normalizing blood clotting
- Protecting against fibrocystic breast disease
- Providing some protection against breast cancer
- Necessary for survival of embryo
- Stimulating osteoblasts for bone building
- Precursor for cortiscosterone production for anti-inflammation
- Necessary for production of nerve myelin
Estrogen dominance is a situation in which there is too much estrogen in relation to progesterone. When a woman fails to ovulate, progesterone cannot reach the optimum 20 – 25 mg. during the final two weeks of a woman’s monthly cycle. This allows estrogen to go unopposed the entire month and upsets the normal progesterone/estrogen balance. During her years of clinical practice, Colleen Galvin, P.A., D.O.M. has discovered that estrogen dominance was responsible for a number of unpleasant side effects in her patients, some of which include bloating, water retention, breast tenderness, and depression. During perimenopause and menopause, estrogen dominance can occur due to imbalances that take place with fluctuating hormones. This can increase the risk for breast and uterine cancer, endometriosis, and fibrocystic breast disease. Estrogen controls several functions in the body, and when it is imbalanced, it cannot do its’ job correctly. Some common functions of estrogen include:
- Producing collagen for skin elasticity
- Detoxifying the brain
- Balancing moods
- Regulating the menstrual cycle
- Maintaining bone strength
- Regulating body temperature
- Setting sleep cycles
- Helping blood flow smoothly
If women have their ovaries removed or they are in natural menopause, testosterone levels drop by 1/3 or more, and it is definitely advisable to replace it along with estrogen because it is the hormone of desire. Besides the bone and sexual benefits, it also acts on the brain, muscles, liver and blood vessels, as it enhances cognitive functions. The negatives of too high a dose of testosterone include susceptibility to baldness, facial hair, acne or deepening of the voice.
Testosterone can add zest to menopause, and monthly surges of this androgen boost wellbeing, sense of personal power, and sex drive.
Testosterone can be the “Impulsive Hormone,” and there is a parallel of information about it in men and women. Those with higher levels are usually single, aggressive, dominating, and take risks, but these impulses can be channeled and controlled in order to avoid problems. In women a little bit can go a long way, as it enhances sexual desires and fantasies, helps make women more easily sexually aroused, to enjoy intercourse better and have more frequent orgasms. Other benefits derived from testosterone are:
- Helping promote bone growth
- Relieving mild depression
- Reduces vasomotor symptoms
- Prevents vaginal atrophy
- Reduces vaginal dryness
- Maintains muscle mass
- Improves workout performances
In hypothyroidism, patients can have a wide variety of symptoms but generally there is slowing of metabolic processes. There is a range of hypothyroidism that consists of subclinical to overt hypothyroidism to myxedema. Patient who are older have fewer signs and symptoms and in both young and old patients there is little correlation between clinical and biochemical manifestations.
Decreased levels of thyroid hormone result in swelling around the eyes and decreased heart rate. A patient’s speech is often slow and the voice is hoarse. Also, decreased reflexes are common. In the later stages, there is accumulation of glycoaminoglycans into interstitial tissues, and this accumulation results in edema of skin, muscle, heart, and striated muscles, which results in symptoms of a round puffy face, loss of hair, and dry skin. Patients also can experience hearing loss, numbness in the extremities, and daytime sleepiness. There is also a decrease in the conversion of carotene to vitamin A, which causes the skin to have a yellowish color. Also hypothyroidism is involved in decreased conversion of estrogen precursors into estrogen, which can result in infertility. Hypothyroid symptoms can include:
- Lethargy and decreased energy
- Cold intolerance
- Muscle cramps
- Muscle pain and stiffness
- Weight gain
- Dry skin
- Mental slowing
- Course hair and skin
Colleen Galvin, P.A., D.O.M. can help women to determine hormonal imbalances, and bio-identical hormone replacement therapy can restore deficient hormones to improve vitality and wellness. Bio-identical hormones have allowed countless women to overcome the symptoms associated with menopause and perimenopause and live healthier, happier lives.