ESTROGEN has an estimated 400 crucial functions in our body and plays many different roles in a womens health, maintaining female reproductive function, cardiovascular health, memory function, bone turnover and weight control by modulating regulation of body fat. For a woman, the ovaries make 60% of estrogen while the other 40% comes from other sources, including the adrenal glands.
The body converts androgens such as DHEA and testosterone made by the adrenals or ovaries into estrogen. Likewise, estrogen plays a vital role in a man’s physiology as well, regulating maturation of sperm and maintenance of libido. But did you know that estrogen is not a molecule? It is rather a group of three different forms of estrogen:
- Estrone: produced in the ovaries before menopause, it becomes the predominant circulating estrogen in post menopause.
- Estradiol: is the major form of estrogen produced in the ovaries in pre-menopausal women, though also produced by the adrenal glands and placenta. It is estradiol that helps with the development of secondary sexual characteristics related to breast development and feminine patterns of fat distribution in young women. Throughout a woman’s menstrual cycling life, estradiol plays an important role in cardiovascular health, memory, bone growth and turnover, and normal maintenance of the female reproductive tract.
- Estriol: is the predominant estrogen of pregnancy, with placental production source. It is much weaker than estradiol.
Estrogens can also be produced by gut bacteria, or derived from plants, called phytoestrogens, or come from a synthetic source, called xenoestrogens, and these form the class generally known as ‘endocrine disruptors’ because they mimic the effects of estrogens and have an overall cumulative effect on the total estrogen levels.
All these estrogens, with their cumulative overall levels, as well as their metabolism and their balance to each-other, will exert a modulating effect on disease risk. In other words, a hormone imbalance stemming from inadequate hormone ratios and inadequate hormone metabolism and excretion will raise one’s risk of development of chronic inflammatory, auto-immune, degenerative diseases and malignancies.
The opposite holds true: hormonal balance leads to protective cardiovascular benefits, maintenance of bone density and avoidance of osteoporosis, memory preservation and brain health, as well as balanced mood and sexual health.
Most women who suffer from decreased estrogen levels and imbalance in progesterone-to-estrogen ratios will present with the following symptoms:
- Hot flashes/night sweats
- Headaches or migraines
- Insomnia or sleep disturbances
- Poor memory/concentration or forgetfullness
- Hair loss
- Dry skin/eyes/hair
- Thinning /aging skin and wrinkles
- Bone loss
- Insulin resistance
- Increased cholesterol
- Poor carbohydrate metabolism with resultant weight gain
- Heart palpitations
- Oily skin /acne
- Lighter/non-existent periods
- Vaginal dryness
- Urinary tract infections
- Depression or depressed / low mood
- Carbohydrate cravings
- Low libido
PROGESTERONE has 300 jobs in the body and over 9,000 genetic mechanisms. The ovaries are the main source of progesterone production before menopause, making approximately 4 to 28 milligrams of progesterone during ovulation from the corpus luteum left behind after the rupture of the dominant follicle releasing the oocyte, ovulation which tends to occur sporadically by the mid-thirties.
This means that progesterone is the first hormone that begins to decline leading to many symptoms of hormone-ratio imbalance.
Women who underwent a total hysterectomy (ovaries were removed as well) and women on oral and hormonal IUD contraceptives that block ovulation are more than likely progesterone deficient.
This is because the synthetic progestins block ovulation, therefore that corpus luteum does not form and the main source of progesterone production is eliminated, leaving many women feeling awful with symptoms listed below:
- Weight gain
- Fluid retention Low body temperature
- Hypothyroidism (under-activity of the thyroid gland)
- Headaches – especially before periods
- Pain and inflammation
- Insomnia or sleep disturbances
- Hair loss
- Bone loss
- PMS Cramps
- Breast pain/benign cysts
- Heavy periods Irregular cycles (periods too close together)
• Spotting before period or breakthrough bleeding
• Mood swings
• Tendency to be stressed easily
Progesterone is your friend, your happy hormone, but more is not better and little goes a long way. These hormones work with each other and influence and modulate how each exert their actions in the body. Therefore, no hormone should be looked at or treated alone in isolation from the others.
TESTOSTERONE is erroneously thought of as a male hormone, but women also need and make testosterone for good health. The ovaries make about 60% of the total testosterone, while the rest comes from DHEA conversion in the adrenal glands.
Women suffering from testosterone deficiency will present with the following symptoms:
• Hot flashes/night sweats
• Aches and pains
• Poor memory
• Thinning skin
• Loss of muscle tone
• Bone loss
• Heart palpitations
• Loss or thinning of pubic hair
• Vaginal dryness
• Loss of libido
• Impaired sexual function or female sexual arousal disorder
Instead of fearing testosterone and its replacement in females, let’s explore the beneficial, protective effects of testosterone: It increases bone mineral density, reduces fractures, increases muscle bulk and tone, maintains lean body mass, strength and stamina, increases libido, increases sense of well-being, improves mood, energy, and memory, lowers cholesterol and prevents heart disease, thickens skin and increases oil production in the skin, increases hair growth, and improves insulin sensitivity.
Any testosterone replacement, if desired and certainly proven by laboratory parameters correlating with presenting symptoms, should be done to restore physiologic levels that lead to resolution of offending symptoms, while providing all the aforementioned protective effects.
DHEA is made by the adrenal glands, and it contributes to the formation of other hormones. About 40% of our estrogen and testosterone are made from the conversion of DHEA.
Therefore, a deficiency in DHEA can trigger significant shortages of these hormones. DHEA levels decline with age, dropping to about 50% of youth-age levels by the time we reach the age of fifty. In our sixties, we typically produce only about 20% of what we did in our youth.
Chronic stress will also affect the adrenal production of DHEA. Individuals suffering with low DHEA levels will experience the following:
• Immune dysfunction
• Greater risk for cancers
• Heart disease in men
• Excess body fat
• Type 2 diabetes complications
• Chronic Inflammatory Disease
• Rheumatoid Arthritis
• Chronic back, neck, and shoulder pain
• Neurodegenerative diseases
• Cognitive decline
There are many natural interventions that can help one modulate the interaction of these hormones to improve symptom management, but ultimately the root-cause of these symptoms must be evaluated, treated and eradicated, following the core principles of Functional Medicine, otherwise all forms of treatment instituted will provide only a temporary relief.
Dietary modifications, lifestyle changes, improvement in the gut health, elimination of endocrine disruptors and possibly other synthetic medications that lead to hormonal imbalance, management of stress, adequate sleep and quality of sleep, as well as exercise regimen should all be considered and employed when working to improve hormonal balance.
As menopause sets in, the botanical interventions will only ameliorate the symptoms related to menopause, and without initiation of bioidentical hormone replacement therapy, they alone will not be modifying the levels of the hormones so important in providing all the beneficial and protective effects to a woman’s or man’s body such as cardiovascular protection, bone and brain health protection, and maintenance of sexual health.
The dose and form of administration should be individualized based on symptoms that correlate with laboratory findings. Form of administration varies when considering treatment of different symptoms, and certain testing modalities correlate better for monitoring therapeutic effects of treatments.
There is no cookie-cut recipe of regimen and protocol for every patient. Each treatment must be individualized based on the individual’s symptoms and root-cause thereof, family and personal medical history, presenting hormonal imbalance, and choice of treatment.