Women and aging: getting older, feeling better, untangling some answers

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on January 10, 2012 at 6:00 AM, updated January 13, 2012 at 11:22 AM

10LGHORMONE.jpgFeeling exhausted and unwell? It's worth trying to find out why, and get your vigor back.

CLEVELAND, OHIO -- Perhaps you've been feeling overwhelmingly tired, losing some hair and gaining weight. Or you are losing weight and don't want to.

If you are a woman in your mid-30s or beyond, and you feel as though you are fighting an uphill battle just to get through the day, maybe it's time to get a few things checked out. (That is, assuming you don't feel that way because you are eating a diet high in refined carbs, sugar and caffeine, and are not getting enough sleep or exercise.)

But be forewarned: Some doctors believe that as women age, they can't expect to maintain the vibrancy of their younger years. Other doctors say it doesn't have to be that way. Those varying attitudes can translate to very different approaches toward testing and treatment for hormone-related deficiencies.

One doctor might do a complete blood work-up, while another might focus on specific tests, depending on the severity of symptoms or whether the patient is in perimenopause or menopause. Some doctors are more inclined to wait for a preponderance of data from studies before shifting their approach; others say that traditional medicine moves too slowly (witness how long it took for studies to address vitamin D deficiency in most of the population).

Dr. Joseph Girgis, an internal medicine doctor whose practice is in Sheffield, falls into the second group. "Optimizing hormones to the levels you used to have helps you feel better," he says. "It has to be done properly, but why should people feel terrible?"

Another wrinkle: What action a doctor will take -- or not take -- once she has the test results. Here, again, opinions vary.

Some doctors may take no action if, say, a patient is in the "normal range" on the lower end of the spectrum of thyroid function. Others will jump in, believing that it's better to act before the problem becomes worse.

What you need to remember: If after seeing your doctor you still aren't feeling well and you don't know why, keep pushing for answers.

Testing can provide answers when women are suffering

Here are some common tests doctors consider when a female patient over 30 complains of extreme fatigue or other symptoms that might imply something is amiss.

Vitamin D. Some doctors will check your vitamin D levels, but many still won't as a matter of course. If not, you should absolutely ask for this test.

"Ninety percent of the patients we check are definitely too low in this," says Dr. Joseph Girgis. "It's important to correct to the appropriate level."

The normal level in our bodies is 30 to 100 nanograms per milliliter. And Girgis is one of many doctors who say that raising your level to a baseline of 30-plus isn't enough. That's why he and others recommend taking 4,000 IU of vitamin D3 a day.

The Recommended Daily Allowance for vitamin D3 supplements has been woefully low for decades -- only recently it was only 400 IU, which researchers said was almost useless. Last summer, it was raised to 600 IU for most adults.

But several studies have shown that nearly all supplements contain about one-third or less of the amount of vitamin D3 they claim to.

Girgis points out that a person will feel far better -- energized and less depressed or fatigued -- if they get the levels in their body up to 50 to 60 than they will at the minimum of 30.

Thyroid. Thyroid function is a hot topic of the moment. Women ranging from workout guru Jillian Michaels to Oprah Winfrey have written or talked about how getting their thyroid levels up to snuff has made all the difference in helping them with their weight and energy.

Dr. Armand Krikorian, an endocrinologist at UH Case Medical Center who teaches at Case Western Reserve University School of Medicine, says checking TSH levels (thyroid stimulating hormone) is often all that's necessary.

"That will capture most instances of thyroid dysfunction," he says. "If I was paying out of pocket, this is the most cost-effective test." If someone is taking a steroid like prednisone, though, he says the TSH results can be misleading.

The thyroid gland makes hormones that regulate the way the body uses energy. It uses iodine from food to make two thyroid hormones: thyroxine (T4) and triiodothyronine (T3).

Testing for those hormone levels has its uses, says Krikorian, but TSH will catch 95 percent of cases.

Girgis says he's seen a number of patients with TSH levels in the "normal" range who still felt awful with symptoms that indicated their thyroid wasn't up to par.

"I will also check free T3 and free T4.

"People come in at the low-normal end of those, which some people in medicine don't think is worth correcting. These patients are feeling terrible, but they're considered 'normal.'

"Often, I think they would benefit from getting those levels higher, and they do -- people tell me they have more energy, their digestion is regular and so on. It can make a huge difference."

There is debate on this, says Dr. Margery Gass, an ob-gyn who heads up the Cleveland-based North American Menopause Society, cautioning that too much thyroid medication could possibly affect cardiovascular health.

Cortisol. Doctors like Gass and Krikorian said they won't check the levels of this stress hormone unless particular symptoms call for it: A "moon" face, or weight gain plus fatigue plus easy bruising, or weight gain that is only in the belly, while arms and legs stay very thin.

"In that case, I'd check it," says Krikorian. "But not on your average person."

Gass says that attention given to problems with adrenal function is considered "fringe." She, too, would generally not advise getting cortisol and DHEA-S tests (a DHEA-S test measures androgen levels, which can tell you how well your adrenal glands are functioning). "DHEA levels drop over time and there has not been good correlation with symptoms," she says. Even if DHEA shows up very low, "It's probably not indicative of anything."

Author and physician Dr. Christiane Northrup, noted for her best-selling books on menopause and women's health, says that it's true cortisol tests "won't show up as anything unless you have something like Addison's disease," which is rare. Cortisol tests also can be problematic because cortisol levels vary by time of day -- they are supposed to be high in the morning and low in the evening.

But that doesn't mean adrenal function shouldn't be checked out. Because if cortisol is high in the evening and low in the morning, "You'll feel miserable -- anxious at night, exhausted in the morning," she says.

She recommends getting a saliva test for adrenal function, a test that must be ordered by a doctor. However, getting it ordered is more likely with a holistic or naturopathic physician, she says.

"In traditional medicine, there are too many doctors who just wait for adrenal failure," Northrup says. "When the horse is out of the barn, they'll go after it."

She advises addressing problems before they get to that point.

Other tests that may be considered:

Progesterone. As women get older, their levels of progesterone decrease. As this happens, women might have symptoms like premenstrual migraines, irregular or excessively heavy periods, or anxiety and nervousness. If a woman is suffering from that, says Northrup, "Bioidentical progesterone supplements can help alleviate the symptoms."

She and other doctors caution against synthetic horomes (Premarin and Provera) which, given at higher doses, have been shown to increase the risk of breast cancer. At the very least, getting tested for progesterone levels will tell you whether you are in full-fledged menopause.

Gass says she would normally not test progesterone levels.

Testosterone. Even women need a healthy level of testosterone, and doctors might run tests on women who are complaining of low libido or vaginal dryness. The range is 20 to 80 nanograms per deciliter, but doctors say a woman who drops from 60 to 20 will notice a big change in how her body feels -- especially in terms of libido and energy.

"Getting a woman back to the higher end can make a huge difference," says Girgis.

Anemia. This is an oldie but goody, and it is still worth checking if you're low on iron. People who are anemic will feel lethargic, and getting the necessary doses of iron will improve their energy.

"Anemia is less common in women after menopause, but anyone can develop a slow-bleeding ulcer or colon cancer that will gradually result in anemia," says Gass. "Thus, a complete blood count and TSH are good tests to begin the evaluation process. Iron level in the low normal range would suggest the need for more foods containing iron or an iron supplement."