smiling middle aged woman next to text that reads a womans guid to hormonal balance and replacement

A Woman’s Guide to Hormonal Balance, Imbalance, and Replacement

Men and Women Are the Same 

All men are really suppressed women. While this phrase is intended to be a bit startling and I use it intentionally to get your attention, it is true that all men and women start out as female. It is the default gender in the developing embryo that once was you.

To make a male, there must be an extra step to inhibit the natural progression to female in the womb, because left alone, the process ends up as a female. That extra step is testosterone and its precursors, thanks to the male (“XY”) chromosome, which inhibits the female development and allows the male development to emerge and express itself.

Female genetics are based on the (“XX”) chromosome, and the woman who becomes pregnant bestows at least one “X” into the mix (either an “X” or the other “X”); alternatively, the man (based on the “XY” chromosome) contributes either an “X” or a “Y” into the mix. This introduces the next startling revelation: it is the man who determines which gender a couple’s baby will be. That is, an “X” from the mom and another “X” from the dad will result in a girl; an “X” from the mom and a “Y” from the dad will result in a boy.

Men and Women Are Different

Whether the path to maleness or femaleness takes place will determine whether the same “stuff” that makes up your genital tissue will become a pair of ovaries or a pair of testicles. Without the inhibition of the female at the hands of that pesky Y-chromosome, described above, then ovaries will emerge as a pair of collections of egg follicles—numbering hundreds of thousands—more than enough to release one at a time each month (what is called your “ovulation”) during your future reproductive lifetime.

The ovaries produce female hormones (just as the testicles produce testosterone, the male hormone). All hormones—whether female or male—are controlled by two small glands in the brain, the pituitary and the hypothalamus, which help direct the production of either ovarian or testicular hormones. In the case of the female, those ovarian hormones are primarily progesterone and estrogen, and their pituitary and hypothalamic control are via other hormones, all working together as something called the “hypothalamic-pituitary-ovarian axis.” While this may seem confusing at first, think of it as dominoes falling.

The Hypothalamic-Pituitary-Ovarian Axis

The hypothalamic-pituitary-ovarian axis is called that simply because it is a linear progression of stimulation from one to the other (like the dominoes falling in sequence). In other words, the hypothalamus in your brain, when it senses your hormones are low, will produce its own hormones that begin a chain reaction to result in your ovaries making the hormones you need. As such, when your hormones are high, your hypothalamus doesn’t stimulate the process to make more; when your hormones are low, they do. It’s like a thermostat.

This linear chain reaction goes like this:

Low estrogen is sensed by your brain’s hypothalamus, which stimulates it to make gonadotropin-releasing hormone (GnRH); GnRH is sensed by your pituitary, which stimulates it to make follicle stimulating hormone (FSH, which causes the follicles in your ovaries to start maturing toward the act of ovulating); and luteinizing hormone (LH, which causes the actual ovulation). And with the follicles matured, estrogen is made; with ovulation, the site of the follicle remains to make progesterone.

Low hormones à hypothalamus makes GnRH à stimulates pituitary to make FSH, LH à follicle development (à estrogen) and ovulation (à progesterone).

Homeostasis: Adventures in Feedback

In the body, the balance of everything is called “homeostasis.” Everything in your working body is balanced—there shouldn’t be too much or too little of anything. That is, a balance based on a “Goldilocks” condition where everything is just right. This balance, homeostasis, is primarily maintained by a feedback system. There are positive feedback and negative feedback sequences at work in nature as well as in the human body.

Positive Feedback: if you’ve ever placed a microphone close to a speaker, it will amplify the sound from the speaker, which goes back into the microphone and then is amplified again. Ultimately, you will hear a high-pitched very loud whine from the speaker. In the human body, an example of positive feedback is the pregnancy labor hormone oxytocin. It is released with stimulation of your uterus (womb) during labor, and the resulting contractions stimulate your pituitary gland to make more oxytocin, which stimulates your uterus even more, until—instead of the whine of an amplified speaker—you hear the whine of your baby! Another example, using oxytocin again, is that stimulation of your breasts with breastfeeding provokes more oxytocin, which creates milk letdown, which your baby consumes and, in doing so, stimulates your breasts some more for more oxytocin and even more milk letdown.

Negative Feedback: in nature, an example of a negative feedback loop is when water flows through a crack in a rock over time, building up enough sediment to obstruct the flow of the water. The more the flow, the more it self-obstructs and slows the flow. In the human body, a prominent negative feedback loops used in homeostasis it the hypothalamic-pituitary-ovarian axis above. When the sex hormones are high, the hypothalamus does not initiate the chain reaction to make more; when they are low, it does.

Estrogen & Progesterone

What Estrogen Does

The human body does not waste its ingredients, using many of them to perform different functions. For example, cholesterol—far from the villain it’s purported to be—is necessary for life, because all of the sex hormones, including estrogen, progesterone, testosterone, etc., begin as cholesterol. Cholesterol itself helps make the fatty insulation of our nerves so our brains can think fast enough to keep our bodies functioning and alive.

Take the cholesterol molecule and knock off a portion of it and voila! you have pregnenolone, a progesterone precursor; remove a hydrogen atom and voila! you have progesterone. Similar alterations can pull other hormones out of the hat, namely estrogen, testosterone, and even non-sexual hormones, such as aldosterone (affects fluid retention) and cortisol (the stress hormone).

How can such small changes make such big differences in the human body

Estrogen is a great example of single molecule used for many purposes:

  • Maintains the blood supply to your baby
  • Builds up tissue lining for implantation after you conceive
  • Increases the size of your breasts
  • Improves circulation
  • Helps maintain your temperature (“thermal regulation”)
  • Affects appetite, body weight, and fat accumulation
  • Affects compensatory actions when your oxygen is low
  • Helps in memory
  • Decreases its own production by inhibiting the hypothalamus (negative feedback)
  • Many others

What Progesterone Does

Progesterone, also in the “cholesterol club,” above, because of its chemical ability to cross-convert among estrogens, testosterone, and progestins, likewise has multiple functions:

  • Matures blood vessels in your uterus where the placenta/pregnancy implants
  • Slows down digestion
  • Affects gland secretions
  • Acts as a muscle relaxant
  • Affects weight, appetite, and fat accumulation
  • Stimulates insulin secretion for sugar control
  • Decreases its own production by inhibiting the hypothalamus (negative feedback)
  • Many others

What Estrogen and Progesterone Do Together

You are designed to reproduce—that is, conceive, grow your baby, and deliver your baby. The cycle of hormone effects on your uterus do that—building up the blood supply for the baby (estrogen) and maturing the blood vessels for proper functioning (progesterone). Prior to conception, they act as a tag team, but during pregnancy, both estrogen and progesterone remain high.

The Feedback Loop

Thinking of your hypothalamus as the beginning and your ovaries as the end of estrogen and progesterone production, respectively, is oversimplifying the whole process. Think of the dominoes, above, as a ring. There is no beginning or end of hormone cycles, except when you are born or when you die. Even with menopause, hormones from your adrenal glands can still cross-convert to estrogens and other hormones.

 

So, rather than being a sequence from A-to-Z, it’s actually a loop. True, when estrogen is high, your hypothalamus is suppressed. But this is followed by decreases in estrogen/progesterone production, and then your hypothalamus is stimulated again.

What Happens When There’s a Wrench in the Works

Since properly functioning feedback loops maintain the balance of homeostasis, when this loop is altered, stopped, or otherwise interfered with, that balance becomes an imbalance. The term, “hormone imbalance,” although it has become a cliché in medicine, is accurate. When there is such an imbalance, what they accomplish daily can fail. This can be anything from acne and constipation (overproduction of progesterone) to the overbuilding of tissue into cancer (overproduction of estrogen).

Another problem can arise when a woman is “stuck” in one part of this cycle, in which progesterone is continuously produced, which obliterates the advantage of the cycle, and with it, stopping of periods, ovulation, and your ability to get pregnant; on the other hand, continuous (non-cyclic) estrogen can lead to precancerous changes in tissue, nausea, painful breasts, headaches, blood pressure changes, and irregular vaginal bleeding and infertility.

Sure, there’s a lot more to the menstrual cycle than your period, but your period is that one outward “Goldilocks” sign that tells you whether things are right or not.

Signs of Hormone Imbalance

When a woman experiences her monthly period, this is an excellent way to check that everything is working just fine—from your hypothalamus to your pituitary to your ovaries. On the other hand, any changes in your monthly cycle is an indication that there is an imbalance.

A professional healthcare provider can help track down where in the cycle the problem is occurring, and this gives you your best chance to fix things and get on with your normal hormonal and sex life. Primary signs and symptoms of a hormonal imbalance are listed below, although this list is not absolute but a blurry designation of hormonal states, since estrogen and progesterone—and their excesses or lack—interact with the other.

Therefore, it is important to understand that this hormone imbalance list has considerable crossover in that too little estrogen can present as if it were too much progesterone, and vice versa. This is because estrogen is considered as if it were an “anti-progesterone” and progesterone is considered as if it were an “anti-estrogen,” that is, to much of one acting as if you had too little of the other and vice versa.

Too much estrogen

  • Stopping of periods (except in pregnancy, in which the inhibiting of your hypothalamus is normal, due to the high estrogen and progesterone that occurs)
  • Heavy periods
  • Frequent periods
  • Mood changes
  • Irritability
  • Depression
  • Irregular menstrual cycle
  • Infertility
  • Weight gain
  • Telangiectasias (little collections of blood vessels under the skin)
  • Increase in the size of moles or warts and of uterine fibroids (benign tumors of the womb)
  • Visual changes (from swelling of the cornea) and need for a change in glasses prescription
  • Breast pain (from fibrocystic changes)
  • Headaches and migraines
  • Diabetes
  • Gallstones
  • Blood clots, thrombophlebitis in the legs
  • Fluid retention
  • Weight gain
  • Palpitations

Too little estrogen

  • Mood changes
  • Insomnia
  • Infertility
  • Changes in sex drive (“libido”)
  • Painful sex
  • Vaginal dryness
  • Bladder incontinence
  • Change away from feminine “figure”
  • Bone density loss (osteoporosis, with risk of bone/hip fracture)
  • Hair loss
  • Nail changes
  • Hot flushes (“hot flashes”)

Too much progesterone

  • Stopping of periods
  • Constipation
  • Abdominal pain
  • Acne
  • Male-pattern hair growth
  • Changes in sex drive (“libido”)
  • Relaxation of ligaments leading to joint pain
  • Immune changes (more susceptible to infection)

Too little progesterone

  • Irregular periods or fading out of periods altogether
  • Insomnia
  • Mood changes/irritability

When Might Women Experience a Hormone Imbalance?

Since the entire hormonal cycle is complex, it can become affected at any point. Below are some ways in which this can happen:

Pregnancy: as stated above, a pregnancy relies on continuous and elevated estrogen and progesterone for the health of your developing baby, as well as for preparation for childbirth and breastfeeding. These elevations stop the cycle.

Birth Control Pills: birth control pills (oral contraceptives) introduce a supply of estrogen and progesterone from outside the body, and the resulting rise in them fool your hypothalamus into assuming the high levels are due to pregnancy. This is why hormonal birth control is often called “pseudopregnancy.”

Breastfeeding: breastfeeding involves other hormones, notably prolactin (the milk letdown hormone) and oxytocin (stimulates lactation). Breastfeeding inhibits your pituitary glands production of LH and FSH, which is necessary for your ovarian follicles to develop and ovulate an egg; the end result is no ovulation and little if any estrogen/progesterone to the cycle. This is why periods stop, typically, during breastfeeding and why lactation has been used as a fairly good (not guaranteed) method of birth control in prior times.

Menopause: As a woman, you were born with hundreds of thousands of egg follicles in your ovaries, which sprang into action with the maturing of your hypothalamic-pituitary-axis (and adrenal glands), called “puberty.” With puberty came your periods, breast development, and other sexual characteristics, such as pubic hair. Although the number of follicles, one being released monthly, would be enough for thousands of years of fertility, all tissues experience an aging sequence, the sum total, of course, being death from old age. For ovarian tissue, this aging effect begins in late midlife.

The official definition of menopause is going a year without any periods. The average age of menopause is 52, but are two important things to note about this milestone:

  1. This is an average, with a spectrum from one’s late thirties until late fifties.
  2. Menopause isn’t like a light that burns out. It is a gradual process, and the approach to menopause can take ten years, in which a woman may notice a spreading out or lightening of her periods.

Tumors: any growths, whether benign or malignant, can have functioning tissue that overrides the balance of homeostasis, when these occur in the hypothalamus, pituitary, and ovary, as well as in other tissues like the breasts and thyroid. The competing influence from these “rogue” players can interfere with your normal cycle.

Premature Menopause: this is when ovarian failure occurs prior to the customary time in a woman’s 40s-50s. Such failure in a woman’s 20s or 30s is a tragic blow against her fertility.

Obesity: fat cells tend to hijack your normal adrenal hormones and convert them into an estrogen. This alters the cyclic nature of estrogen function, and it can result in stopping of bleeding, prolonged bleeding, and even cancerous changes due to consistent stimulation from the hormone.

Taking Certain Medications

Certain medications can affect your hormones. For example, antidepressants and antipsychotics can cause an increase in the pituitary hormone, prolactin—the milk-producing (lactation) hormone, making your body think it is breastfeeding (see impact of breastfeeding above), with a subsequent decrease in all hormones. Thyroid medication can muck up the hypothalamic-pituitary-ovarian axis, too. So can certain herbal supplements and natural remedies. The National Women’s Health Network is a valuable resource for an extensive list of these supplements.

 

Should Hormone Imbalances Be Treated? Isn’t That Unnatural?

There are those who argue that manipulating one’s hormones is unnatural. Before discussing whether an imbalance in your hormones should be treated, it is interesting to consider the following:

In prior times before modern medicine, women of reproductive age were either virgins, pregnant, breastfeeding, or dead. Consider what this means: without modern contraception, the typical sequence was puberty, pregnancy, breastfeeding, then pregnancy again. Pregnancy was risky business, with a high risk of death in childbirth in those times. So, continuing to menopause was actually rare. In modern times, however, our technology has outpaced our tendencies for a shorter lifespan. None of us were designed to last much past the age of our 40s, yet today it is the norm.

This means that age-related things like breast cancer, heart disease, hypertension, stroke, and—yes, menopause—are new to our species (looking at our natural history over thousands of years). It turns out that what is unnatural is not manipulating your hormones when they’re misbehaving; what is unnatural is when a woman lives long enough to go through menopause. Since we all buy into that, why not buy into maintaining a woman’s quality of life that she had before menopause or during her life in hormone balance?

Unlike menopause, hormone imbalance before menopause is temporary, allowing the benefit of temporary management until an abnormality or condition gets fixed.

What Treatments Are Available for Hormone Imbalances?

The easy answer to how to treat a hormone imbalance is to re-balance the hormonal situation. While it may seem obvious to give more estrogen, for example, if there’s low estrogen, the smarter way to approach it is to see why your estrogen may be too low and fix that problem. In other words, fix the cause, not the effect.

However, when there are no causes that can be fixed and you are left with the remedy of simply supplying what you lack, no other treatments have proven more beneficial or reliable than oral contraceptives for pre-menopausal women and hormone replacement therapy (HRT, consisting of estrogen or estrogen + progesterone) for menopausal women.

With birth control pills, your hormonal life is corrected while allowing the cause of a hormone imbalance to fix itself in the background, since most hormone imbalances are temporary, self-resolving problems. With HRT in menopause, therapy is designed to make you as much like your pre-menopausal self as you used to be, with the goal of restoring your quality of life and protecting your bones.

The main two hormones, as seem obvious, are estrogen and progesterone. The synthetic hormones (constructed molecules) work best for stability with birth control pills; however, the subtle changes of menopause do best with the identical hormones you were born to make—that is, what are called “bio-identical” hormones.

Hormones vs “Bio-identical” Hormones

Above there is a discussion of how just knocking off an atom can change a hormone from one type to another. Hormones work as a type of key that unlocks areas on nerves called “receptors,” and when they fit into these receptors, the receptors become activated to start other processes. While generic hormones may fit into these receptors partially and cause some of a hormone’s effects, only bio-identical hormones have the exact molecular shape to fill the receptors the way the receptors were designed to be filled and make them function the exact way they were designed to function.

Therefore, the advantage of using bio-identical hormones is your best assurance that you are being restored to the way you are supposed to be functioning. Why is this important?

Take the case of narcotics. In your body, you make natural morphine-like painkillers, opioids called endorphins. Notice I said “morphine-like.” Filling your opioid receptors with artificial opioids can cause the tolerance, addiction, and dependence you won’t see with your own natural endorphins. This is just one example of how using the exact molecule is a more natural approach.

Benefits and Risks or HRT

The benefits are obvious—regulation of periods, contraception, manipulation to restore fertility and, in menopausal women, improvement in their quality of life to that which they were accustomed before their menopause (i.e., reduction in hot flashes, weight gain, irritability, and even hip fractures; better cognitive and memory function).

The risks, however, can be significant. Cholesterol increases—when it actually does act like a villain—can cause atherosclerosis and heart disease, clotting problems (causing life-threatening blood clots), and an increased risk of stroke. Therefore, if you’ve had a history of heart disease, hypertension, stroke, or previous blood clots, you shouldn’t take hormones. On the other hand, if you haven’t, and no problems arise during the first year of HRT, it is less likely problems will.

Add smoking to the mix, and every risk increases to a point that you should not use hormonal therapy if you smoke! (Another good reason to quit.) What puzzles researchers is that while this is true about smoking, smoking seems to act like an “anti-estrogen,” making it more likely you’ll suffer from signs and symptoms of estrogen deficiency.

Sleep and Hormones Go Hand-in-Hand

The fact that hormonal imbalance can affect your sleep health (insomnia) is misleading. Good sleep habits are not dependent on hormones, but good sleep and hormone balance are dependent on each other. That is, they both can suffer when one of them is a problem, so both have to be normal. This introduces the obvious co-factors like exercise and good nutrition and diet habits for total well-being.

Conclusion

With hormones having hundreds of functions, it is no surprise that your whole-body health is affected by their proper functioning, excesses, or deficiencies. This means not only more famous hormonal effects, but your sleep, activities of daily living, body systems, and social, sexual, and recreational life; they all roll into one amazing combination of processes, an important one of which is the life you share with your hormones.

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