The Feminine Mystique: Hormone Health from Puberty to Postmenopause
By Thea Deley

Frequently hormones are blamed for the nature of a woman's mood, when in reality they are more often the determinant of her health. That's because too much estrogen may lead to premenstrual syndrome (PMS), uterine fibroids and the growth of certain cancers, while too little can interfere with fertility or bring on perimenopausal symptoms such as hot flashes. Striking that delicate balance may be the key to resolving many women's health issues—because hormones control much more than reproduction.

"There are hundreds of tissues in the body that have hormone receptors," says Susan Lark, M.D., author of The PMS Self-Help Book (Celestial Arts, 1984). "Progesterone acts as a natural diuretic and has a constricting effect on blood vessels and muscles. Estrogen causes fluid and salt retention in tissues and has a relaxing effect on blood vessels. Estrogen is also growth-enhancing," which is why it instigates tissue growths like fibroids, breast lumps and endometriosis. "Progesterone is the opposite—it helps tissue mature, not keep growing," says Lark.

Since the brain also contains hormone receptors, estrogen and progesterone have emotional as well as physical effects. "Progesterone is the body's natural antianxiety and anti-irritation agent," says Stephanie DeGraff Bender, M.A., author of The Power of Perimenopause (Crown Publishing, 1999). "Estrogen is the body's natural antidepressant. You can imagine what would happen if either of those were out of balance." During the early reproductive years, imbalances in these hormonal levels crop up in the form of PMS. As women enter perimenopause—commonly in their 30s and 40s—hormone levels naturally fluctuate as ovary functions gradually begin to wind down and the number of ova (eggs) decreases.

With fewer eggs and irregular ovulations, women's progesterone levels decrease. John Lee, M.D., author of What Your Doctor May Not Tell You About Premenopause (Warner Books, 1999) says, "Progesterone becomes deficient in about 55 percent of women in North America by the time they're 35 years old." He points to environmental toxins, particularly external estrogen sources called xenoestrogens, which upset the balance between progesterone and estrogen.

Symptoms of this imbalance vary. A woman may skip menstrual periods or experience shorter cycles due to diminishing levels of progesterone. Since estrogen thickens the endometrium, excessive estrogen overstimulates the endometrium and results in heavier periods, while declining levels of estrogen means lighter periods.

In response to declining estrogen levels, folicle-stimulating hormone (FSH) levels increase as the body attempts to induce an egg to ripen. FSH dilates and fills capillaries just below the skin with blood, giving rise to night sweats and hot flashes. Furthermore, as estrogen levels diminish, so does collagen, which gives skin its elasticity. Less estrogen also causes thinning and drying of vaginal tissue, which may reduce sensation and make intercourse uncomfortable.

"Some women are predisposed to hormonal imbalances," says Bender. In addition to heredity, a woman's weight—too low or too high—diet, stress and lifestyle may make her more susceptible. For instance, avoiding exercise, skipping meals, eating sporadically, or ingesting too much sugar, refined carbohydrates and caffeine make blood sugar levels shoot up, then drop dramatically. "When blood sugar is low," Bender says, "the body releases adrenaline, the fight-or-flight hormone. Adrenaline covers up the progesterone receptor site—the place where progesterone needs to attach to be used by the body for natural anti-anxiety, anti-irritation effects." Anxiety, depression, an inability to concentrate and mood swings may follow.

"When a woman goes in to her health care practitioner complaining of these symptoms," says Bender, "the practitioner says, 'You're still cycling [menstruating], so you're not menopausal.' Frequently, if you're in your mid- to late-30s, you're told you need antidepressants." Both Bender and Lark believe there are times when antidepressants are appropriate. However, they prefer to prescribe foods, supplements, herbs, lifestyle changes and natural hormones to ease imbalances.

Technically, a woman is in menopause when 12 consecutive months go by without a menstrual period. Until then, she should consider herself fertile and continue to use birth control. "The conventional practice of medicine gives the message to women that when they hit menopause they're getting old," says Shari Lieberman, Ph.D., author of Get Off the Menopause Roller Coaster (Avery, 2000). "But women are supposed to go through menopause. They're not supposed to get pregnant when they're 60." Considering that today many women live one-third of their lives after menopause, it's hardly the end of the road.

According to Lark, estrogen levels in menopausal women drop 70-90 percent and progesterone drops to practically nothing. But the body is innovative. "After menopause, estrogen production shifts from ovaries to fat cells," Bender says, "so we're producing a different type of estrogen from a different source."

Maintaining Balance
There are three types of estrogen. Estradiol is the most potent and is produced only by the ovaries. Estrone is converted from estradiol, or, as estradiol levels decline in perimenopause, synthesized in fat cells. Estriol, the weakest form of estrogen, is produced by the placenta or converted from estrone. Although conventional medicine treats menopause as an estrogen deficiency, Lee says, "It's really the lack of progesterone that causes problems, since estrogen and progesterone work together."

While menopause is a natural transition, "American women are much more likely to experience hot flashes than Asian, Ethiopian or Mayan women," Lark says. "We eat a primarily dairy-based diet. In countries where they eat a diet closer to the earth, one that's richer in phytonutrients and estrogen content, women are much more cushioned than we are against menopausal symptoms." This suggests younger women can protect themselves from a difficult menopause "by making healthful lifestyle changes now," Lieberman says. "That means eating well, taking a multivitamin, exercising and reducing stress."

Ironically, that advice applies to just about any hormonal imbalance. Even though you may feel out of control when your hormones are, remember that there are always options.

Thea Deley is a freelance writer specializing in alternative health.