Archive for Hormones
The Basics of Experiencing Anxious Moments From Drugs and Hormones
Posted by: | CommentsSome women have feelings of depression and anxiety. Ellen, a 49-year-old mother whose grown child recently left home to work, was one. An active community volunteer, she had a stable marriage and home life. When she came in to see me, she said, “My periods are still pretty regular, the only change is that they’re much lighter than they used to be. But my emotions are out of control. I feel like I’m having panic attacks.”
Ellen’s hormone profile suggested that she was menopausal. (Her estradiol level, when measured with a saliva sample, was less than 1 pg/ml.) However, because she still had a relatively regular menstrual cycle, she assumed, correctly, that she couldn’t be menopausal. (Remember that a woman is not considered menopausal until she has stopped menstruating completely.) Ellen was unfamiliar with the term perimenopause, so she was unsure of how she should interpret her symptoms. She wondered if she was crazy. Before she came to see me, she had seen a psychiatrist who prescribed Xanax and someone else who prescribed a low-dose birth control pill after testing her estrogen. Was it confusing? Completely.
Ellen’s panic attacks weren’t the result of having either too much time on her hands or too much to do. In fact, she seemed quite content with the balance of things in her life before they started. In her case, low progesterone levels may have been the driving force behind the panic. The low-dose birth control pills she was taking may have helped address the estrogen decline. (It’s interesting to note that the estrogen in these oral contraceptives is often of a higher amount and greater potency than the estrogen prescribed as part of a hormone replacement therapy regimen specifically for perimenopausal symptoms.) The other important variable in low-dose oral contraceptives is that they contain synthetic progestins. Synthetic progestins suppress the body’s production of progesterone. In some women, synthetic progestins greatly worsen anxiety, which may be because their bodies respond poorly to the shortage of the hormone nature intended for them to have.
Ellen had no family history of either heart disease or osteoporosis. She didn’t necessarily want to use hormone replacement therapy at this time. Her uterine lining was still being stimulated enough to produce monthly periods. (The estrogen in the oral contraceptives may have had this stimulatory effect.) It seemed appropriate to try progesterone therapy, 200 mg of natural micronized progesterone daily for three weeks. Progesterone does not have to be used in conjunction with estrogen, even though estrogen must not be used alone in women who still have a uterus.
Ellen discontinued the birth control pill and felt better within a week. She started using micronized natural progesterone and felt significantly less anxious. This solution may sound too simplistic. But the reality is that in some cases we treat symptoms with different medications and end up treating the side effects of one medication with another drug. In Ellen’s case, it would be important to keep the whole picture straight by following up and monitoring her estrogen level. To do this, we would test her estrogen and progesterone levels again in thirty days. This would tell us more about the ratio of estrogen and progesterone in her body and ensure that the dosage of natural progesterone was appropriate for her.
Mary, one of the perimenopausal women we’ve already met, also chose to try natural progesterone to alleviate her persistent anxiety. I’m not suggesting that natural progesterone is a panacea for anxiety, but I do want to point out that many health providers may not offer it as an option. Although natural progesterone has been used in Europe for decades, it is still something of an “alternative” approach in the United States. More frequently, American women are prescribed an antianxiety or antidepressant medication. If you are feeling persistent anxiety or panic attacks, natural progesterone is among the choices you may want to consider.
Why is progesterone often effective in managing feelings of anxiety? While estrogen appears to have an elevating effect on our moods, progesterone seems to calm or relax us, there really is an exquisite balance between these two hormones in our bodies. Produced in massive amounts in pregnant women, progesterone may be the reason why some women feel peaceful and serene when they are expecting. In fact, antianxiety medications like Valium act on similar sites in the brain as progesterone. Progesterone is sometimes used to treat PMS, based on the theory that inadequate levels of this hormone in the second half of the menstrual cycle contribute to premenstrual anxiety. An out-of-kilter ratio between estrogen and progesterone may also account in part for anxiety or depression during perimenopause.
I say “in part” because some scientists believe that women who become depressed during perimenopause are predisposed toward this depression for other reasons, and that women with perimenopausal depression are likely to have been depressed before their reproductive hormones begin to change. I don’t totally agree with this. I see too many women for whom life had been moving along smoothly before they reached the perimenopausal phase, and who then found themselves feeling depressed for the first time.
Sadness and worry in our forties may have a hormonal component, but these feelings can also be heightened by our circumstances. Reaching our forties can have a sobering effect, as we realize we are not Immortal. Many women face losses during their forties: their marriage may end, their children leave home, their parents may become ill or die. I don’t want to give the impression that perimenopausal depression or anxiety is an “either-or” situation, we can’t say that hormones either have everything or nothing to do with the way we feel. We are neither ruled by our hormones nor exempt from their effects. Rather, I’m suggesting that we should look carefully at hormonal influences on our moods and be prepared to take an inventory of other personal issues that can contribute to our feelings of unhappiness or tension.
The Basics of Hormones For Perimenopause – Natural versus Synthetic
Posted by: | CommentsThe word natural can be tricky to interpret when we’re talking about HRT. Progesterone receptor cells in our bodies will recognize synthetic progestins, but natural progesterone and synthetic progestins act differently in the body and produce different effects on progesterone receptor sites. Natural progesterone molecules fit exactly into progesterone receptor cells.
The distinction between “natural” and “synthetic” is very important. First, I want to point out that we’re not saying here that “natural” is good and “synthetic” is bad. Not at all. But it’s important to understand that natural and synthetic hormones have very specific effects on the body, and that these effects are different. There are appropriate uses for both natural and synthetic hormones, but they should not be considered interchangeable. For instance, some women have trouble tolerating synthetic progestins, whether they take them as part of an HRT regimen or in an oral contraceptive, finding that they produce unwelcome side effects. Some women say they feel weepy, irritable, and bloated when taking a medication containing a synthetic progestin. For these women, natural progesterone is an option to consider.
Second, once women are clear about the differences between natural progesterone and synthetic progestins, lots of them want to know about “natural” estrogen. Many women are surprised to learn that some commercially prepared estrogens match the effects of the estrogens produced by the body and so are considered natural. They are chemically identical to estrogens produced by the body and will affect estrogen receptor cells in the same way. Meanwhile Premarin, which contains certain types of estrogen that are unique to horses, is not considered a natural form of estrogen. Remember, it is the chemical structure of a hormone, not its source that determines if it is natural or synthetic. A natural hormone may be developed in the laboratory using pharmaceutical-grade products.
Third, the word natural is sometimes used pretty loosely. Some herbal preparations claim to be natural remedies for symptoms of perimenopause or premenstrual syndrome. They may be marketed as phytoestrogens or wild yam cream and be plant- or herb-based. If you choose to try one of these preparations, find out all you can about what it contains. It’s wise to let your health care provider know what you’re using and how much.
The Basics of Sex Drive Hormones During Perimenopause
Posted by: | CommentsTestosterone plays a strong role in triggering sexual desire, in both men and women. An androgen, testosterone is produced in males and females, although in much smaller amounts in women. It’s important to note here that changes in sexual function are shared by both men and women, although when it comes to midlife transitions, our culture still focuses largely on the female reproductive aspects. But lessening libido and longer arousal time aren’t strictly female, the 20-year-old man who needed only five seconds to achieve an erection matures into a 50-year-old who needs thirty seconds and eventually becomes a 70-year-old who may take six minutes or more. Shifts in testosterone levels are part of the changes, as well as shifts in DHEA, sometimes called the “hormone of youth” because it appears in high levels in people under twenty, may also be implicated.
Men too may be surprised by physical or emotional changes that almost seem to sneak up on them, and they may have their own flirtations with anti-aging or youth-enhancing products. Three men I know took the hormone DHEA, allured perhaps by its implied promise of youth and virility. For one of these men, DHEA didn’t reverse the aging process as is sometimes claimed. Instead, it led to dangerously elevated levels of testosterone and estradiol. DHEA is a precursor hormone, when it occurs naturally in the body, it turns into other hormones like testosterone and estradiol. In this man’s case, DHEA may have spiked his production of other hormones to unhealthy levels. Despite the risks, and without evaluation by a health care provider to see if their DHEA dosage and hormone levels are appropriate, two of the three men decided to keep taking it because they found the idea of staying young and virile so attractive. The male midlife transition is certainly different, less overt and much less widely discussed. As our subjective experience of female sexuality alters and expands in our forties, we should be aware that male physiological and emotional responses are also steeped in change.