Art of Being Female

A popular topic that seems to come up more often these days with my friends and I have to do with hormones. To be honest, this subject was not a big topic as we rose through the ranks of motherhood and raising our children. It was a whisper that I seemed to hear from women who were my mother’s age when I was a young mother, mixed in with “ Wait until you’re older”. Mood swings, hot flashes and yo-you weight gain are some other symptoms I would hear about. But when I was younger, before and after having children, it didn’t seem like any of my doctors placed any importance on checking or educating me about hormones. It hasn’t been until the last few years that I have really started to research and listen, as now I’m in the “window” of the dreaded “M” word… Dr. Peggy DeLong Branson is a California licensed naturopathic doctor that I was introduced to a few years ago and she has been a miracle worker on a few levels for me. She provides an integrative and holistic approach to health care, and focuses on identifying and treating the root cause of the sickness or disease, and treating by the most natural methods possible.

Hormones play a huge role in overall health. A hormone is a chemical messenger that is secreted in the blood which travels to other organs to regulate body function. There are a variety of different hormones, and often times patients come in to my office with the request “I just want to check my hormones”. I have to explain to them that it’s not that simple. There are sex hormones- like estrogen and testosterone, there are thyroid hormones, there are also stress hormones, the list goes on. The term hormone is very ambiguous, and often times when people are wanting their hormones to be tested, they don’t even really know which ones they are interested in looking at. Hormones are vital for overall health and wellness, but the key is in knowing which hormones to look at when. There isn’t a one size fits all approach when it comes to hormonal health. For women who are still having monthly periods, there are significant swings in sex hormones from one part of their cycle to the next. Many of my patients are under a lot of stress and are exhausted, for those people it’s the cortisol and thyroid levels that I’m often interested in. When it comes to menopause, and all the fun symptoms that come along with it, we are looking at hormones in a much different way. Estrogen helps to keep your heart healthy and your bones dense too, helping to prevent osteoporosis. Hormones are required for life, not just for women, but for everyone. Making sure you’re hormones are healthy, happy and functioning well makes for a healthy and happy you!

At what age do you recommend to do a hormone panel? Some women outside of menopause don’t realize how hormones affect their mood, weight, skin, and hair at any age.

For the average person I don’t necessarily recommend a full hormone panel. Hormones need to be looked at based on the current symptoms someone is experiencing, not just a “well lets just test this to make sure it’s ok”. Hormones are absolutely vital for health so when there’s something off with your hormone levels, you are going to feel it the majority of the time. For a menstruating woman, I would consider looking at certain hormone levels on specific days of the cycle if periods are irregular, if they are struggling with fertility or if there are marked PMS symptoms like insomnia or anxiety in the second half of the cycle. For someone having a regular 28 day period without any menstrual issues just testing their hormones isn’t going to give you any valuable information at all. While I don’t think that sex hormones need to be tested as a baseline, I do think that every single person should have their thyroid levels tested annually, along with other basic blood work which look at blood cells, liver function, kidney function, and vitamin D (which actually behaves like a hormone in the body!). While often times more thorough testing is needed, I think that the average person needs at least those foundational labs to make sure the basic markers for health are all in working order. Thyroid hormone is the hormone in your body that regulates metabolism. Thyroid dysfunction can commonly result in fatigue, weight gain, constipation and hair loss just to name a few of the big symptoms. There is A LOT that goes into hormonal health and hormone balancing. My suggestion to people who are interested in having their hormones tested is to sit down with a licensed naturopathic doctor or an integrative medical doctor who is well versed in hormone testing and treatment.

If you are planning on getting pregnant, or are pregnant, how important is it to check your hormones and what is the safest way to keep in balance?

Hormones play a huge role in your body’s ability to get pregnant. Often times struggles with fertility are entirely due to a hormone imbalance. For someone who is having difficulty getting pregnant, I think that having indicated hormone levels tested is the best first step. During pregnancy hormones likes estrogen and progesterone are much different from the non-pregnant state. Progesterone levels are very important in maintaining a pregnancy and therefore, progesterone levels are often tested in women with recurrent miscarriages. Something that does need to be tested regularly during pregnancy is thyroid hormone, as thyroid hormones are absolutely mandatory for the baby’s growth and development. Having low thyroid hormone levels can also be a cause of infertility in women.

Can you explain the difference between perimenopause and menopause, and the ages when most likely to occur?

That’s a great question. In terms of age, a lot of menopause timing comes down to genetics, so if your mom went through an early menopause, it’s possible you will too. The average age for my patients who are experiencing the unpleasant side effects of menopause is about 50 years old. I had one patient who went in to early menopause at 36, and I have had patients who still continue having a monthly cycle well in to their late 50’s. The timing of menopause is variable. Menopause is the end of menstruation and medically, menopause is defined as having gone one year without a period. Perimenopause, is therefore everything leading up to that point. There are some specialists who say that perimenopause starts it’s gradual descent at 35 years old. One thing is for sure, in your late 30’s and early 40’s your ovaries start preparing, (all be it early) to close up shop permanently. One thing that is important to note about menopause is that it is a natural progression of life. Some people skate through menopause, and the symptoms don’t even phase them. Other people are miserable for a couple months or sometimes even a couple years with symptoms.

What are some of the most common symptoms to recognize of perimenopause?

Often times perimenopausal symptoms are much more vague than the overt hot flashes and night sweats of menopause. Some people simply experience a significant increase in PMS symptoms, and others will have more pronounced anxiety or insomnia. Some patients struggle with weight gain, while others can’t seem to kick their brain fog. It’s common for periods to get more irregular during perimenopause, which can mean skipping a month of your period, or even having cycles where you are bleeding for a greater number of days than is typical for you. Many perimenopausal women report mood swings, or that they are more irritable than they feel like they should be. Often times women will say “I’m not normally like that” or “I don’t know why that bothers me so much, it didn’t use to”

What types of tests and lab panels should we ask our doctor to run? Sometimes we have to be vocal or proactive. Are there certain days during the month/your cycle that are best to take them?

That’s a hard question to answer well. My best answer is that it depends on what is going on with you. As I mentioned above, certain hormones are tested in certain situations. For a fertility workup, you want specific day 3 hormone levels to start with, but for someone who is having a regular period, those labs wouldn’t really be indicated. One thing for sure is that anyone who is struggling with pronounced fatigue should have their thyroid hormones tested, as well as their cortisol levels. There are a lot of different ways to test thyroid levels, but the tests that I run are TSH, Free T3, Free T4, reverse T3 as well as the antibodies to test for autoimmune thyroid disorders. When looking at cortisol I prefer to have a snapshot of one entire day, so I send my patients home with a salivary cortisol test kit so I can have 4 measurable cortisol levels. Other than salivary cortisol testing, I do not test hormones in saliva. Blood hormone levels are the gold-standard for diagnosis, treatment and management of hormone related issues. In terms of what tests would be indicated for each individual, again my best suggestion is to see a doctor who is well versed in hormonal health.

What are the different options of hormone therapy?

When it comes to menopause the hormones that are often prescribed are estrogen, progesterone and sometimes testosterone. They can be taken as oral pills, creams that you apply to your skin, or even as vaginal suppositories. For thyroid, the most typical management is with oral prescription thyroid medications like Synthroid, Cytomel or natural desiccated thyroid (NDT) like Naturethroid. Birth control pills are another option for hormone therapy in someone who is still menstruating, as is the Mirena and the Skyla IUD.

What are some natural options to hormone therapy, or choices to use in addition to?

For menopause there are a lot of alternatives, and it’s important to keep in mind that menopause is natural! For the people who breeze right through menopause, hormone therapy and herbal hormone support often isn’t required, but for those women out there suffering there are options! Often times herbs like black cohosh can help to support estrogen levels, and I have seen great improvement in my patients symptoms from focusing on herbs that support the liver and the adrenal glands. In my practice, I prescribe bio-identical hormones, but that is not the only way to manage menopausal symptoms. In terms of thyroid management, NDT is a more natural thyroid medication that many of my patients do really well on. The key with thyroid is finding out what works well for you, not what works well for other people or what your doctor likes prescribing. I have had some patients with hypothyroidism, hyperthyroidism as well as autoimmune thyroid disorders who I have treated without any prescription thyroid medication at all. For these patients the focus is on adrenal health and diet/lifestyle modifications.