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Extreme Hormone Makeover: The Problems of Hormonal Imbalance and HRT Managed Beautifully
By Donna White, ND


Ruth came to the medical clinic where I was consulting last fall. She had a complete hysterectomy almost one year earlier, losing both ovaries along with her uterus. On her intake form for her hormone evaluation she wrote, "Since my surgery in November, with taking synthetic hormones, I have never felt 'right.' My first month, December, was okay. By mid-month January I felt stressed. In February, I felt so anxious that I felt suicidal and described myself to my doctor as having PMS times 3000. I cry easily. I feel helpless and out-of-control. I just want to feel normal again. Despite exercise, my waist is thickening. I want to feel sexual again. I want to take what my body needs but not what it does not need. I want to know what my hormone levels are no one has ever tested them. Please help me."

Unfortunately, Ruth is far from alone. Millions of women struggle with symptoms of hormonal imbalance, from PMS to peri-menopausal symptoms. Others must deal with menopause or problems associated with menopause. Some women who stopped traditional hormone replacement therapy (HRT) after the release of the Women's Health Initiative findings (more about that later) are now experiencing symptoms again. Any woman who has dealt with hormonal imbalance can attest to the fact that we can be affected physically, mentally, and especially emotionally. Symptoms commonly associated with any of these hormone-related issues are:

Emotional:

  • Anxiety/irritability/mood swings
  • Depression

Mental:

  • Poor concentration
  • Decreased sex drive
  • Sleep disturbances

Physical:

  • Heavy periods/irregular bleeding or cycles
  • Breast pain or cysts
  • Hot flashes/night sweats
  • Vaginal dryness/painful intercourse
  • Headaches/migraines
  • Oily or extremely dry skin
  • Weight gain
  • Bone loss

Do any of these symptoms sound familiar to you? If so, you may be a candidate for an extreme hormone makeover! But before explaining what an extreme hormone makeover is, we had better start by describing what hormones are and how they work. Hormones are chemical messengers released from glands to travel the body via the blood stream. They "speak" to certain cells in the body, giving them that particular hormone's message or command. We know these as the properties of the hormones. Let's take a look at the properties of the three hormone types most commonly used in a hormone makeover: progesterone, estrogens, and androgens. We'll start with progesterone.

Properties of Progesterone:

  • Decreases menstrual bleeding and spotting
  • Decreases fat storage/increases metabolism
  • Protects against cancer, especially breast cancer
  • Helps prevent hardening of the arteries
  • Improves brain function
  • Reduces water retention
  • Normalizes blood sugar
  • Reduces irritability and anxiety
  • Raises HDL/lowers triglycerides
  • Helps reduce hormonal headaches/migraines
  • Reduces carbohydrate cravings
  • Helps restore normal sleep patterns
  • Balances excess estrogen or estrogen dominance

Progesterone is a key hormone to understand because it is the hormone whose levels drop earliest in most women. Many women become progesterone-deficient in their mid-thirties, and on average, a woman's progesterone level has dropped by 75% by the time she is 50. As the level declines, many women start noticing the symptoms associated with low progesterone levels. These include:

  • PMS
  • Anxiety/Mood swings
  • Fluid Retention
  • Break-through Bleeding/Irregular cycles
  • Hormonal Headaches
  • Fibroids
  • Bone Loss
  • Sleep disturbances
  • Breast Cysts/Breast Pain
  • Symptoms of low thyroid
  • Depression
  • Fatigue
  • Infertility

Clearly, progesterone is not just the hormone of pregnancy, but is vital to a woman's well being all through her reproductive years.

The next hormone that begins to drop or fluctuate as we age is estrogen. We all know that girls begin producing estrogen in significant amounts at puberty, that this rise in estrogens is responsible for her sexual development, and that estrogens exert tremendous influence over a woman throughout her reproductive life, as the list below illustrates:

Properties of Estrogens:

  • Regulate the menstrual cycle
  • Plump the vaginal tissue
  • Slow bone loss
  • Protect the heart
  • Slow aging
  • Uplift mood
  • Lower LDL/raise HDL
  • Add moisture to the skin
  • Enable brain function

The stimulative effects of estrogens are very powerful and complex, which is why one leading author calls the estrogens (there are 3 major estrogens) "angels of light and angels of death." Since estrogens play such an enormous role in a woman's life, she may experience problems as estrogen levels begin to fall as she matures. Typically, estrogen levels drop 30-60% around the time a woman turns 50, and before leveling off at menopause, estrogen levels can be high one day and low the next. If a woman's estrogens drop too low at times during her cycle or as she approaches menopause, she may display these symptoms of estrogen deficiency:

  • Hot flashes/night sweats
  • Fatigue
  • Headaches
  • Vaginal/bladder infections
  • Forgetfulness
  • Insomnia
  • Decreased verbal skills
  • Irregular bleeding
  • Low sex drive
  • Bone loss
  • Depression/tearfulness

If a woman's estradiol level remains low for a long time, she has a higher risk of heart disease, declining cognitive function, and increased bone loss.

Normally in a woman's monthly cycle, estrogen is the primary hormone the first two weeks, but with ovulation she also produces progesterone for the second two weeks, which modulates the stimulatory effects of estrogen in her body. When both hormones drop, the menstrual flow begins and the cycle starts over again. Unfortunately, a variety of stressors can deplete her progesterone levels, leading to a state of estrogen dominance. Without adequate progesterone to moderate the effects of estrogen, she may experience the progesterone-deficiency symptoms listed earlier. This stress-induced hormone imbalance is very common today. Another challenge to hormone balance is the high level of synthetic hormones in our food supply that require the protective balancing effect of progesterone at higher levels. Some authorities suggest that at least half of all women are progesterone-deficient by age 35, while others believe the number of progesterone-deficient women is much higher. The good news is that progesterone deficiency is easy to treat, as I will explain later in this article.

Often, levels of the androgens, namely testosterone, also drop as a woman ages, and since testosterone and related androgens play pivotal roles in building tissue such as bone, skin, and muscle, as well as protecting the heart and enhancing brain function and sex drive, a decline in testosterone may cause the following symptoms:

  • Loss of sex drive/impaired sexual function
  • Aches and pains
  • Thinning skin
  • Loss of muscle tone
  • Depression/demodulation
  • Hot Flashes
  • Bone Loss
  • Incontinence
  • Vaginal dryness
  • Poor memory

Some women find that instead of dropping, their testosterone levels actually begin to rise. Common symptoms of excess androgens are:

  • Acne/oily skin
  • Facial hair
  • Ovarian cysts
  • Thinning scalp hair
  • Painful nipples
  • Agitation/irritability

Now that we understand the problems caused by hormone imbalances, what can we do about them? Treatments have been available for years, but traditional approaches like HRT can have serious side effects. Non-bio-identical hormones are either synthetic or animal-derived (such as Premarin, conjugated equine estrogen isolated from pregnant mares' urine). Any hormone that is not bio-identical to human hormones does not have the same exact properties, and can therefore have powerful unintended effects. In fact, a large study called The Women's Health Initiative found that the most common form of HRT, Prempro, (synthetic progesterone plus conjugated equine estrogen isolated from pregnant mares' urine) has many notable side effects:

  • 26% higher risk of breast cancer
  • 23% higher risk of heart disease
  • 38% higher risk of stroke
  • 100% higher risk of blood clots
  • 100% higher risk of dementia
  • 94% higher risk of abnormal mammograms after the first year.

These and other side effects have driven women and their physicians to look for other solutions that do not carry such high risks. Many other women who have never taken HRT are also looking for ways to relieve hormonal-imbalance symptoms through extreme hormone makeovers too.

The primary tool in extreme hormone makeover is natural or bio-identical hormone therapy (BHRT) as indicated for each woman. "Bio-identical" is a more accurate term than "natural," because these hormones match human hormones exactly. They are derived from plants and transformed into chemical structures that exactly match human hormones. There is no difference in function, the body recognizes them as if it had made them itself, and they do not interfere with the body's own hormone production. Dosed properly, BHRT has a long history of safe and successful use, especially in Europe.

Women taking these hormones give such feed back as, "I feel like me again," "I can't believe the difference," "You have given me my life back," "My husband thanks you," "I feel like I did when I was in my twenties," and one patient reported that "I am now having complete thoughts and I want to be around people again." (These are all actual comments from real patients.) No wonder then that a very high percentage of women on BHRT stay on it: 97% compared to around 20% in traditional HRT.

When a woman comes to a practitioner trained in BHRT and related treatment methods, here is what she gets: 1) a hormone evaluation, 2) education on the properties of hormones and symptoms of deficiencies, 3) a saliva test to check her hormone levels, 4) testing for related issues such as thyroid problems, adrenal disorders, and blood sugar imbalance, 5) recommendations of supplements or herbal therapies, 6) BHRT, either prescription or over-the-counter, and 7) dietary and lifestyle recommendations. The practitioner will use her symptoms, history, and hormone levels to tailor a treatment to her needs and requests.

Why test saliva instead of blood to determine hormone levels? Because while blood tests obviously measure levels of hormones in the blood stream, the saliva test has been proven to accurately reflect hormone levels in the tissues, where it really counts. It makes sense, because it is in the tissues, not the bloodstream, where hormones exert their influence. It is also non-invasive, easy to perform at specific times in a woman's cycle, and provides an excellent response for dosing accuracy. That is, saliva testing allows one to know not only the patient's baseline hormone levels, but also whether she is taking appropriate doses for her. This is an important advantage because experts have long known that women's responses to natural hormones vary greatly, some women requiring higher doses, and others needing minute doses. After prescribing BHRT, the practitioner will monitor the response of symptoms to the treatment to ensure accuracy in therapy.

BHRT is rapidly becoming the most sought-after and effective therapy for women with hormonal imbalances. Bio-identical hormones come in a variety of forms, including capsules, patches, creams, and troches, which are lozenges that dissolve under the tongue.

We now know that topical application is the safest and most efficient method, because delivery of hormones into the bloodstream via the skin mimics the delivery of hormones from the ovaries to the blood. Hormones taken by mouth can have differing effects due to the trip through the digestive tract and liver.

Since progesterone is typically the first hormone to decrease, let's cover progesterone supplementation first. Many women are now aware of the beneficial properties of progesterone and purchase (OTC) over-the-counter brands. This is acceptable because of the lack of side effects associated with the use of progesterone. In fact, many practitioners start their patients on OTC brands since they offer a great average starting dose.

There are now hundreds of brands available without a prescription, but the brand I recommended to the medical doctors at the clinics where I have consulted is Endocreme Serum. I chose it for very specific reasons. First of all, it is the only brand that I know of that has a sustained-release delivery system, ensuring that the woman gets a stable dose of progesterone from the very first. Competing brands may take months to work, since progesterone tends to accumulate in the fat tissue. Also, Endocreme Serum's delivery system is highly efficient and very similar to that of an invisible patch. The hormone is surrounded in nannosomes, which are 500 times smaller than skin cells, which greatly improve(s) absorption. The pharmacologist who developed this brand also added to the formula five types of organic yams to enhance the effect of the progesterone at the cellular level. In summary, Endocreme Serum far surpasses the other leading brands in delivery of the hormone in both amount of and rate of absorption. Practitioners also appreciate the measuring lines on the application dropper, which allows precise dosing.

The next hormones many patients need are the estrogens. Sometimes the herbal estrogens (phyto-estrogens), such as black cohosh and/or sprouted soy supplements, will manage the low-estrogen symptoms, but if the saliva test indicates lower-than-normal levels of estrogens, and in particular of estradiol, the most powerful estrogen, the herbal supplements may not be strong enough to bring the levels back into the normal range. In that case, the patient may need prescription bio-identical estrogens.

For lower-than-normal testosterone levels, the practitioner can prescribe either testosterone or dihydroepiandrosterone (DHEA). He or she should confirm the deficiency before treatment, and monitor treatment carefully, since DHEA can raise testosterone and estrogen levels.
After prescribing appropriate bio-identical hormones, the practitioner may order additional lab tests, such as thyroid panels and saliva assays for adrenal function. He or she will also check blood sugar levels and recommend appropriate therapies and dietary changes.

Here are examples of some actual extreme hormone makeovers, starting with Ruth's. You will recall her comments and cry for help in the introduction of this article. After her hysterectomy at age 41, she had been placed on 1.25mg daily of Premarin along with 5 mg of a synthetic progesterone for 16 days out of the month, which I thought was odd because no woman without a uterus needs the risk associated with synthetic progesterone. BHRT practitioners do, however, recommend bio-identical progesterone for all women whether or not they have a uterus, because of all of the beneficial properties of progesterone. Most women on an estrogen-only regime because of hysterectomy are subjected to effects of the estrogen without the protective benefits of progesterone, which is why many of these women have breast pain or cysts. Ruth was no exception, and in addition to breast pain and the debilitating emotional symptoms mentioned before, she also suffered from fatigue, weight gain (probably from the HRT), heart palpations, and very low sex drive. She has a lot of trouble with foggy thinking and poor concentration. The HRT had not even helped her extreme vaginal dryness. At my suggestion, Ruth's doctor immediately stopped the HRT and switched her to natural estrogen by prescription, along with topical natural progesterone. The rest of her protocol included a good multiple vitamin mineral formula, Essential Fatty Acids, and a bone-building formula. Ruth returned after only four weeks with an amazing report: she "did not feel foreign to" herself anymore, as she had on the HRT. She described the switch-over as a great success. Her breast pain was gone. Her thinking had improved dramatically. She still had some fatigue, however. We ordered a saliva test, and instructed her to eat foods that could help manage her blood sugar and control her weight. From her saliva test we discovered that she had reduced adrenal function from years of stress, so nutrients to support adrenal function were the final component she needed to have a beautiful and successful extreme hormone makeover.

Kay (age 37) came in to the clinic because all of her efforts to lose weight had failed. Kay worked out regularly and diligently watched her diet. She was convinced that she had a thyroid problem because her son had just been diagnosed with hypothyroidism. She did have many symptoms that did seem to indicate that her suspicion might be correct: she was tired and cold, and could not lose weight. She felt depressed and had premenstrual headaches. She knew her sex hormones must be out of balance too, because prior to her periods she had anxiety, irritability, and water retention. She hoped that if she balanced her hormones, she would start to lose weight. The first step for Kay was use of the topical progesterone Endocreme. She also began taking a multiple vitamin formula. Kay took home a saliva test to perform on day 21 of her next cycle, and an order for a thyroid panel. When she came back for her second visit, she remarked what a difference she noticed from the progesterone. She was sleeping better, and the hormonal headaches and PMS were gone! Her lab results clearly showed that she did not have a thyroid problem by any standard. However, the saliva test indicated that she had very high levels of the stress hormone cortisol and estradiol, the strongest estrogen. This imbalance was reducing her thyroid function. Once key dietary supplements had helped reduce these levels, she achieved her weight-loss goals and feels like for the first time that her hormones are balanced.

The last extreme hormone makeover was for Laura, age 47. She came in after learning that her migraines were hormone-related. Her doctor had prescribed a synthetic hormone contraceptive patch to regulate her very irregular cycles, and she was also using a bio-identical estrogen patch the week before her period to prevent pre-menstrual migraines. Laura was concerned about this regime because she had breast cysts and a strong family history of breast cancer. She had noticed that over the past few years her menstrual cycles had really lightened up, lasting only about 2 days. She noticed hot flashes and significant depression with crying the week before her cycle. These symptoms were accompanied by vaginal dryness. We understood her concerns about being on the synthetic hormones, and the doctor stopped those immediately. As you may have noticed, some of her symptoms are related to low estrogen, so she continued to apply the estrogen patch as directed, and added Endocreme Serum days 7 through 28 of her cycle. This was enough to stop the migraines! Since the saliva test results showed that her testosterone was also low, the overseeing medical doctor ordered topical testosterone. Laura's breast cysts have disappeared, and perhaps more importantly, she is relieved knowing that progesterone protects against breast cancer in many ways. She no longer takes antidepressants or has hot flashes. At this point, her symptoms are managed beautifully - an exciting and successful extreme hormone makeover!

I hope this article will inspire and encourage women, because every woman who suffers hormone-related symptoms deserves an extreme hormone makeover.

Dr. White holds a Doctorate in Naturopathic Medicine, SCNM 2002 and is Board Certified by the North Carolina Board of Naturopathic Examiners and by the AAMA (American Alternative Medical Association). She specializes in Natural Bio-Identical Hormone Replacement Therapy (BHRT).

Dr. White is a regular presenter and educator for the Professional Compounding Centers of America Bio-Identical Hormone Replacement Therapy for physicians and pharmacists. She writes hormone protocols and is a consultant on BHRT for medical doctors. She has made over 200 presentations for medical practitioners, medical associations and lay people. Additionally, she teaches classes for physicians and practitioners on BHRT and teaches natural medicine classes for college adult continuing education classes.

Dr. White is frequently interviewed by local radio and television stations and has hosted 3 natural medicine radio programs heard on various stations around the country. She has been published in magazines and journals. She is author of an upcoming interactive CD on BHRT to be published Spring 2004.

She is founder of Heavenly Hormones, which is educational presentations for women about BHRT and founder of Hormone Solutions, A BHRT consulting and seminar company for physicians and pharmacists. Additionally is co-founder and Medical Director for BioHormones, a computer application for medical professionals for use with BHRT.