The causes of estrogen dominance are much more complex than the ratio between progesterone and estrogen. Estrogen dominance may be caused by a variety of environmental factors, including exposure to certain plastics, eating commercially fed animals whose diet may contain hormones, exposure to pesticides, excess caffeine, and living very stressful lifestyles. One common cause of estrogen dominance is the formation of active metabolites that have estrogen actions. Your antiaging doctor can measure how your body metabolizes estrogen and more importantly recommend ways it can be altered.
Judith is a 54-year-old patient who was a candidate for hormone replacement. She hadn’t had a period for five months, and was suffering from night sweats and brain fog. She also reported a history of fibroids, FCBD, very heavy bleeding during her cycle and increasing PMS toward the end of her cycle. Although she may have multiple hormone deficiencies, her history indicates estrogen dominance.
Estrogen dominance refers to a possible imbalance between estrogen and progesterone. The symptoms of estrogen dominance include:
Cold hands and feet
Increased cancer risk
Dense Breast on mammograms
Treating estrogen dominance involves lifestyle changes, use of bio-identical hormones and certain supplements. The best way to restore hormone balance is to work with a physician to identify the causes of estrogen dominance. Maintaining a healthy weight is also essential, as is reducing alcohol consumption and eating a low-fat diet that helps reduce toxic estrogen metabolites.
The Function of Progesterone
Progesterone keeps the uterus quiet by protecting a pregnancy if an egg is fertilized. It also balances the effect of estradiol on building the lining of the uterus. If estrogen goes unopposed by progesterone, the lining is thickened and the woman experiences a much heavier cycle.
Progesterone increases a chemical in the brain called GABA – the body’s natural tranquilizer. (Anti-aging doctors refer to progesterone as the “calming hormone.”)
When progesterone is absent, you may experience anxiety, irritability, insomnia and even hot flashes. Without progesterone, a woman will experience more breast tenderness, and premenstrual headaches may increase in the perimenopausal years.
Progestin is Not Progesterone
When seeking Hormone Replacement Therapy, don’t be confused by Provera or methxyprogestin. They are not progesterone. These two medications belong to a class of drugs known as progestins, and are not bio-identical to the progesterone Mother Nature produces in your body. (Designed to look similar to progesterone, progestins are molecules that trick the body into believing it is receiving actual progesterone.)
Unfortunately, progestins increase the risk of breast cancer, and decrease the protection estradiol provides for the heart. In addition, while natural progesterone increases bone formation, a number of reported cases suggest that Provera contributes to osteoporosis.
Bioidentical Progesterone in Menopause
Bioidentical or Human Identical hormone progesterone decreases the risk of breast cancer and increases the heart protective properties of estrogen. It is also neuroprotective, increases hair growth, and facilitates good sleep.
Replacing Progesterone in Perimenopause
Replacing progesterone with bioidentical progesterone is often helpful in menstruating women, and it can be given as a gel or cream. Both will work, but it is difficult to measure the level in the blood if a cream is used. (It can be measured in the saliva or urine.) Oral progesterone can have additional benefits on calming the brain and enhancing sleep.
Using progesterone may help with irregular cycles and heavy menses, and can often prevent the migraine headaches that occur one week before the cycle.
Progesterone Replacement in Menopause
There are a number of options in progesterone replacement in the menopausal woman. For example, some women will take progesterone daily while others will use progesterone 10-15 days a month. There are benefits to either approach, and it’s best to consult your anti-aging doctor to explore the method that’s best for you.
Your hormones begin to change around age 35, with the interval from 35 until your last menstrual cycle called perimenopause. In general, PMS increases, and your cycle becomes heavier. This is caused by cycles where ovulation does not occur. If a woman does not ovulate, or has a delay in ovulation, progesterone is not released (or is released too late in the cycle), causing an imbalance between estrogen and progesterone.
The symptoms of perimenopause are often triggered by other endocrine abnormalities. For example, because stress is associated with changes in adrenal hormones, balancing out the adrenal gland can often help a woman get through the ups and downs of perimenopause.
Pregnenolone is the called the grandmother steroid. It is derived from cholesterol, and can convert into a number of hormones. It has an effect on coping, blood sugar regulation, memory and even color appreciation.
Cortisol prepares the body for battle. In acute stress situations, both cortisol and DHEA increase. The rise in cortisol shunts blood back to the brain’s more primitive areas – putting the body into a reactive mode. (After all, if you need to run through a burning room, it’s best to react quickly and not think too long about it.) Blood is also redirected from the gastrointestinal and immune systems toward the muscles, so you have enough energy to carry out the task at hand. In addition, blood sugar goes up, and adrenaline is released to provide needed energy.
In our culture, stress is the usual cause of elevated cortisol levels. Over long periods of time, too much cortisol promotes unnecessary fat in the abdomen, as if the body were preparing for a battle that never comes. Prolonged production of cortisol results in blood sugar elevation, which in turn, causes insulin levels to rise. And higher insulin levels trigger a number of chemical reactions that result in inflammation.
In addition, high cortisol levels may:
Shrink the short-term memory area of your brain.
Depress the immune system and compromise the health of the gastrointestinal system, causing some patients to develop ulcers, constipation and other inflammatory diseases of the bowel.
Decreases estradiol, triggering the symptoms of menopause.