Hormones-A Fine Balance
In my practice I see the hormonal results of 21st century Western living. Some traditional doctors do not like the phrase ‘balance the hormones’, but to me it makes sense.
Throughout a woman’s life, hormones go up and down. This can run smoothly, or not. Many women experience a cycle change with lifestyle. Emotional or physical stress, travel, sleep deprivation or erratic diet. Around the time of the perimenopause hormones can be very out of balance, resulting in irregular periods, heavy periods, mood swings, flushes and brain fog. Keeping a fine balance can be influenced by lifestyle.
The two main female hormones are oestrogen and progesterone. Their levels and ratio vary, leading to symptoms. As well as other major hormones such as thyroid and cortisol, women also have a small amount of male hormone too. These are all ultimately controlled by a small gland in our brain called the pituitary. All the hormones affect one another and can have a knock-on effect.
Measuring hormones can be difficult. Blood tests can give a snap shot and are less helpful after the age of 45 when investigating menopause. A clinical history is far more important.
There are many different hormone tests, and some are more useful than others. They can also be quite expensive. It is always good to start with a good medical history and examination with a doctor who can look for patterns and indicators into hormones being out of balance. The right test can then be chosen to do further ‘detective work’. Many women come to see me to ask for an oestrogen level check in the blood, but I often have to explain that this is not always the most useful thing to look at.
There are common patterns, that as doctors, we can diagnose and treat. Polycystic ovarian syndrome, hypothyroid, perimenopause, etc. When looking at addressing imbalances of hormones, many patients would rather get to the root cause than just take a pill. This is ever so true in polycystic ovarian syndrome (PCOS) in particular which is a condition on the rise.
One aspect of PCOS is that hormone metabolism of the male hormone Testosterone, which is present in small amounts in women, can start to favour a certain metabolic pathway called 5 alpha reductase (5AR). This can result in metabolites, or bi-products, which are even more androgenic or male like, leading to acne, weight gain round the middle, mood swings and irregular menstrual cycles. The irregular menstrual cycle then leads on to more oestrogen and less progesterone, which further drives on the 5AR pathway.
This pathway can be blocked by strong prescription drugs. This can be useful in men with prostate cancer as the 5AR pathway can also be over used in male patients and the drugs are designed to block this pathway. These drugs can be powerful, with lots of side effects. For women, with this dominant 5AR pathway, it can be interesting to try a dietary and lifestyle approach to try and make an improvement. Some herbal remedies along with optimisation of nutrients such as zinc, can also reduce the 5AR pathway, but more gently and balancing than drugs. I have used this to good effect in treating some cases of PCOS.
One patient I saw was a 30-year-old student whose PCOS was causing very erratic periods, weight gain and low mood. She was fed up. She was rapidly gaining weight and losing her confidence. When she came to see me in the summer of 2017, she had stopped going out and had missed out on her studies. She had ended up being prescribed the pill and an anti-depressant and felt awful. Slowly, we worked through her diet, blood sugar balance and a range of supplements. She worked on stress reduction with some lifestyle techniques such as daily 10-minute meditations and sleep prioritisation. She corrected some nutritional imbalances she had and slowly over the next 6 months she weaned off the medication and her periods returned to normal.
To me, her hormones needed a rebalance. Sometimes medications can be an absolute life saver, but sometimes we need to peel away the layers and get back to the root cause and look at diet and lifestyle to put the balance back. We obviously need more research into some of these lifestyle factors which can affect our hormonal pathways. In the meantime, I like to try and take a safe natural approach where possible and do some good.