Female Hormone Balancing

The purpose of this article is to present the naturopathic view of female hormone imbalances. I will briefly review the most recent scientific research on estrogen and describe the physiological effects of estrogen and progesterone. The role of the stress hormones will be considered along with the safe and effective natural solutions available.

In July 2002 the scientific research community was rocked by the news of the latest long-term study on hormone replacement therapy. A ten-year clinical trial conducted by the National Institutes of Health, studying over 16,000 women, was abruptly halted by a safety monitoring board because the rate of several life threatening diseases among the subjects rose above the agreed upon safety levels. Pulmonary embolism risk (blood clots in the lungs) among these thousands of women had gone up 114%, heart attacks and cardiac death increased 29%, breast cancer rates experienced a 26% rise, and there was a 41% increase in risk of stroke. There were reductions in colon cancer risk and hip fractures that were not significant enough to outweigh the dangers.

One might assume the drug being tested, prempro, was new or unfamiliar, but in fact, it was then used by six million women in the USA, and premarin, the estrogen contained in prempro, has been prescribed widely since the early 1960's. Forty years after its introduction to the USA, premarin, the most widely used form of estrogen, has been determined to be no longer safe. This latest study confirms research conducted over the last thirty years on the benefits and risks of estrogen therapy. Estrogen has now been proven to increase the risk of heart attacks and strokes and does not help to improve the health of the cardiovascular system as previously thought.

The myth promoted by drug company advertising over the last forty years is that estrogen deficiency is the major problem creating female hormone symptoms at menopause. However, in natural medicine we view menopausal symptoms as a sign of overall hormone imbalance in both the ovarian hormones and the hormones that generate stress response produced by the adrenal glands.

Dr. Peter Ellison of Harvard University has pioneered the use of salivary hormone testing. He has found that in industrialized countries women have estrogen levels that are at the high extreme of the world wide levels measured and should be considered abnormal. Dr. Ellison believes these abnormally high levels of estrogen may relate to our current high levels of breast and uterine cancer. In his studies conducted on people from all over the world, he demonstrates a relationship between hormone levels, diet and exercise. An inactive woman who consumes more calories than she uses will have elevated estrogen levels. Dr. Ellison has shown how the tendency of Americans to overeat and under-exercise, reflected in the 61% of the population that is overweight or obese, explains the tendency toward higher estrogen levels.

Excessive estrogen levels are further promoted by exposure to xenoestrogens, which are chemical compounds found widely in our environment, mostly as byproducts of the petrochemical industry. These toxic compounds in the air and water and exert a powerful estrogen-like effect when they enter the female body. One commonly unrecognized source of xenoestrogens derives from heating plastic food containers or Styrofoam cups in microwaves, which releases xenoestrogens from the plastic into the food or liquid that is consumed. Using glass containers prevents this problem.

The imbalance between estrogen and progesterone is further exacerbated by the fact that many women experience lower than optimum progesterone levels. This in combination with estrogen excess leads to a variety of problems. It is the balanced ratio of these two hormones that maintains healthy body functioning; an excess of either can create problems.

Progesterone is the pro-gestational hormone. Its role in fertility is to keep the uterine lining intact when a woman becomes pregnant. Whereas estrogen promotes movement of salt and minerals into cells, progesterone protects the integrity and function of cell membranes, the outside lining of cells. As part of its antagonistic role to estrogen, progesterone is a diuretic. Progesterone increases fat-burning metabolism and has an anti-inflammatory role. It maintains proper cell oxygen levels and importantly protects against the negative effects of estrogen. It is often difficult for women to determine if they are low in progesterone because this can occur even in the course of a monthly period.

Stress also reduces progesterone production by chaining the levels of two other hormones, cortisol and DHEA. When the ratio of cortisol to DHEA shifts due to chronic stress, a phenomenon known as pregnenolone steal occurs wherein progesterone is shunted into the stress hormone pathways, making less progesterone available for its important role in many body functions. The vast majority of women athletes I have worked with find relief from their female hormone symptoms as they correct their cortisol and DHEA ratio.

The key to achieving optimum physical functioning for women and to safely relieve the symptoms of menopause is to balance the adrenal hormones while establishing an appropriate diet, to eliminate any known source of stress and to balance progesterone and estrogen levels. Either an excess or deficiency of any of these hormones will create an imbalance.

Case Study #2: Emily S.

Emily is a 52 year-old runner whose major complaint was a 10-15% reduction in her marathon times in the last year alone. She also suffered from anxiety, inability to sleep, low sex drive, low energy, excess neck and shoulder tension, decreased stamina and the beginnings of osteoporosis. Her run times had begun to decrease in the several years before menopause and the steady decline was troubling her. She was also beginning to experience the onset of fatigue after her longer training runs, rather than the usual pick up in energy she had been accustomed to with exercise. Fatigue after training in a person used to the boost exercise can provide is a key indicator of stress hormone problems. She was evaluated by testing the following hormone levels: progesterone, estrogen, testosterone, cortisol, DHEA and melatonin; all lab assays were taken from saliva samples. A mother of two, she stated that the best she ever felt in her life was when she was pregnant, a comment women frequently make when they are chronically low in progesterone. It was determined that her estrogen levels were normal, but because her progesterone levels were so low, she was experiencing estrogen dominance, as the ratio of the two hormones was abnormal. She also had low cortisol and DHEA levels and low melatonin. In Emily's case we had nowhere to go but up! She was advised to take a specific dose of progesterone to bring her into the right balance between progesterone and estrogen and to undertake a complete nutritional and dietary program to correct her cortisol and DHEA imbalances. She also used melatonin for one month in the evenings, in conjunction with progesterone, to restore her sleep cycle.

Within three nights her sleep and anxiety had improved. Within the first month of the program Emily reported that her sex drive and energy had returned and her neck and shoulder tension had disappeared. In many cases such dramatic improvements have a downside. Now one year into her program, she is on a low maintenance dose of progesterone and remains symptom free as long as she carefully controls her blood sugar and avoids extended periods of over-exercise.

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