Sunday, February 24, 2008

Hormonal Changes in The Change of Life

A new granddaughter entered my life last week, December Lynne Moore. I am so excited to have this new addition to our family; out of 17 grandchildren she is only the fourth girl.

My son and daughter-in-law already have 3 little boys age 5 and under; a new daughter will certainly change the dynamics of their family! Derrick, the oldest, is the little helper, and is doing what he can to help Mommy and his baby sister, and he asks frequently to hold her. Skyler at first didn't even want to see his sister. He's not sure about this new addition to the family that is taking Mommy's attention and he would rather ignore her. Collin, just two, has always had separation anxiety when either of his parents leave. As long as Mommy or Daddy stay with him, he seems ok having this toy baby around. But life has changed for all of them, and there is nothing any of them can do to change it back to the way it was before.

I've been without hot water for a week and a half. Something is wrong with the hot water heater. There were some problems so they couldn't get the part up until Friday. Then the part didn't work. They said they wouldn't be back until Monday. No matter how many calls I made, I couldn't get anyone to come up on Saturday. I'm still without hot water and I can't change it.

So many things happen in our lives, in our relationships, with our health, that no matter what we may do, we can't change. Things are out of our hands; we have no control over them. Going through "the change of life," or menopause, is one of them. We can't control the fact that our bodies are changing. But there are things we can do to make those changes easier to deal with.

As I said in the last blog, menopause is defined as that point in time when our periods stop permanently. Hormonal changes begin to occur before the actual menopause, and this period is called perimenopause, and may last from two to eight years.

Contrary to popular opinion, estrogen levels often remain relatively stable during perimenopause. They usually don't decrease until less than a year before the last menstrual period. During the menstrual years, the primary strong estrogen that the body produces is estradiol. During perimenopause, the primary strong estrogen changes to estrone, produced both in the ovaries and in the body fat. Estriol is another estrogen that is produced in fairly large amounts, but has a weaker affect on uterine and breast tissue. Estriol is the primary estrogen produced during pregnancy.

Testosterone levels usually do not fall during perimenopause unless there is excessive stress in a woman's life, at which time DHEA (precursor to testosterone) levels may fall, leading to less testosterone.

On the other hand, progesterone levels do begin to fall in perimenopause, often long before changes in estrogen or testosterone. This will often cause changes in the length, duration or heaviness of the periods, and is actually the most significant issue for many perimenopausal women.

All though reproduction is usually no longer an important goal during perimenopause, the "reproductive" hormones continue to play vital, health-enhancing roles in the body, evidenced by the fact that there are hormone receptors found in almost every organ of our bodies.

Among many other roles, estrogen, androgens (like testosterone and DHEA), and progesterone are important in maintaining strong and healthy bones and muscles and resilient vaginal and urethral tissue. Both estrogen and progesterone are important for maintaining a healthy collagen layer in the skin.

Progesterone is necessary for the body to make cortisol, the hormone that deals with physical and emotional stress, cortisone, the body's own anti-inflammatory, and aldosterone, which helps regulate fluid levels in the body.

Because the risk of heart attacks is much lower in women than in men until menopause, it has long been felt that these hormones played an important role in preventing heart disease.

Because of these reasons, for years women have been told that hormone replacement therapy (HRT) was the best thing for them as they reached the menopausal years, with the belief and sometimes evidence that there was positive effects on menopausal symptoms, cardiovascular disease, osteoporosis, vaginal and urinary symptoms, Alzheimer's disease, and possibly aging itself.

However, recent studies have discounted some of these effects. Most of these recent studies have used a combination of horse estrogens and synthetic progestins, (brand names Premarin, Provera, and Prempro). Premarin is made from estrogens from pregnant mare's urine. The principle horse estrogen in Premarin is called equilin, which is not found in humans. Equilin's effects on the lining of the uterus are up to 1,000 times stronger than the effects of human estrogen, and it also has much strnger effects on breast tissue.

Provera is a synthetic molecule that is similar to progesterone but not similar enough to call it progesterone. The molecule is called a progestin, meaning that it attaches to the progesterone receptors in the body and has a few progesterone-like effects. Studies have shown Provera to increase the risk of heart attacks, and it has several unpleasant side effects.

It has been shown that combination HRT with these "un-human" hormones seems to increase the risk of breast cancer, blood clots, stroke, and heart attacks. This has many women wondering how to deal with the symptoms of menopause and how to treat osteoporosis if they choose to not use or discontinue HRT.

It is important to remember that menopause is a natural process for the female body, and not a disease. Many women experience the cessation of their periods without any symptoms, receiving no treatment, and go on to live long, healthy and productive lives. Hormones continue to be produced (though in smaller amounts) in the ovaries, and may also be produced by the adreanl glands, body fat, liver, breast tissue, pineal gland and even hair follicles!

Whether or not a woman experiences symptoms during perimenopause and menopause depends on numerous factors, including but not limited to overall physical health, emotional and spiritual well-being, nutritional status, lifestyle and diet, how stress is dealt with, and genetics.

We will continue the discussion of hormone replacement therapy in the next blog, and talk about "bio-identical" hormones.

"Finding Joy"

Assignment Three: When difficult things or people seem impossible to change and life seems out of control, remember three things:
  1. There are always an infinite number of possibilities.
  2. Act, don't react.
  3. I can always change my attitude.

I used to believe that when I came to a stuck place that I didn't seem to be able to change, I would only have one or two choices to make, and often neither of them would work. Then I learned from my friend, Hans, that in actuality there are always an infinite number of possibilities to work through problems. A simple example: I wake up to find my car won't start. I have a very important meeting at work. Living alone with no one else to drive me, the only choice appears to be that I will have to call someone to come fix the car and be late and miss the meeting. I'm stuck. I can't change the fact that my car doesn't work.

But if the meeting is that important to me, I can now put on my thinking cap and brainstorm. I think of every possible way I could get to work, whether they are practical or not. I could ride my bike, call a friend to take me, call a taxi, ask the repair place to take me, rent a car, call a co-worker to get me; or possibly I could call my work and rearrange the time of the meeting. or do the meeting over the phone on a conference call while the car is getting fixed, etc. etc. When I start to think of all the possibilities, suddenly the "unchangable" becomes possible.

When something seemingly bad happens that I can't change, I can either react to the situation with anger, frustration and fear, or act to resolve it or accept it. When I found out I wasn't going to have hot water for another four days, I reacted for a moment with anger. Then I decided to let the anger go and work on resolving it by finding another plumber. When I couldn't find a plumber to come on a Saturday, I started reacting with frustration. I decided to let it go and imagined myself as a pioneer heating my water for washing and bathing.

Then I began to see how very blessed I was, because unlike the pioneers, I didn't have to go out in the snow to the well for water. I didn't have to haul all the water into the house in buckets. I didn't have to chop the wood and build a fire to heat the water on. And I knew that this was going to end in four days. And my attitude about the situation changed, so I didn't have to hold onto the anger and frustration. Gratitude is the best attitude adjustment there is!!

Until we meet again,

Dr. Judi


Karen Ahlstrom said...

The picture and title on this blog entry reminded me of a question I have.

My whole life (since puberty) I've had pretty bad acne on my face and upper back. I've treated it with OTC benzol peroxide, occasionally I've been perscribed oral or topical antibiotics, and more recently tretinoin (generic Retinol cream). My mom and certain doctors used to comfort me by saying that once I got pregnant, the hormonal changes would clear it right up once and for all.

Well, I did get pregnant almost a year ago, and the opposite happened. The acne got worse! It also changed position -- from my cheeks to my jawline and neck. It's also still pretty bad on my back and shoulders.

I heard that acne medicine can cause birth defects, so I stopped using anything except a mild benzol peroxide face wash, and just sucked it up and lived with the acne for the sake of the baby.

Here are my questions: Now that she's been born, can I go back to using the retinol cream, or would it hurt her in some way by entering the breastmilk? What about asking my doctor for a course of antibiotics to get rid of my current outbreak? Is there any good reason the acne has changed position? I see advertisements on TV for Proactiv -- do you know if it works or if it's safe while breastfeeding? Can I ever hope to be done with this? Is there something else I should try?

Thanks Dr. Judi!

Love Karen Ahlstrom

Dr. Judi said...

What happened when you had your baby was you turned into an adult:) Adult acne is more often around the jawline and neck, back and shoulders.

Tretinoin shouldn't be a problem nursing since only a very small amount is absorbed into the milk. However, in the summer it's important to watch the sun. Topical antibiotics are less a problem for nursing than oral antibiotics, which can increase candida (thrush, breast infections, diaper rashes, vaginal infections, etc.).

Alternatively, the gut may be the problem, especially candida. Often when I have a patient cut out sugars and yeast from their diet for a month and take a week's worth of anti-fungal medication like Diflucan, which doesn't hurt the baby because sometimes these medicines are given for thrush, there is a dramatic decrease in acne. A recent study suggests that sugar intake is highly associated with acne, as well as milk.

I have found that a cream or gel of niacinamide and azaleic acid made by a compounding pharmacist can be very helpful. Using a topical antibiotic gel in the morning and the cream at night can reduce comedones fairly quickly.

As far as I know, Proactiv is safe for nursing mothers.

It takes about 6 weeks for skin cells to go through their cycles, so any treatment you undertake you want to try for at least that long.

Patricia said...

What does it mean when your FSH is too high? What kinds of symptoms would you be having with this?

Thanks Patricia