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The Balancing Act

Women's Health Women's Health

Today’s women—from late teens through 70s—are active, engaged, involved and determined to not be temporarily derailed by age-related female issues. Here’s how to help them achieve and maintain balance.

You probably do see more women than men in your practice. Women tend to immediately try to get to the root cause of any issue they encounter, and tend to be acutely aware of how they feel. If they feel “off” they will conduct internet research and then make a visit. (And indeed, when curiosity piques, internet searching and reading ensues.) And although the current young 20-something generation of women is much, much different than the Baby Boomer women, the one thing they do have in common is the desire to address health issues immediately and as “naturally” as possible.

Another factor in common? Hormones. Just one that is off somehow can have impact. Hormone expert Sara Gottfried MD, New York Times bestselling author of The Hormone Cure and The Hormone Reset Diet, and her newest book, Younger, explained that 20-something women tend to feel the effects of poorly managed stress and weight gain which is often caused by high cortisol (released during stress). High cortisol can generate sugar cravings/food addictions, weight and fat gain and depression; it can “pull other hormones off line,” she said. In late 20s, sex hormones estrogen, progesterone and testosterone start to slowly decrease.

Hormone issues become a bit more common and prominent in a woman’s 30s, when progesterone levels begin to decline. This may be felt in night sweats, interrupted sleep and menstrual cycles that are not as regular; progesterone resistance, said Dr. Gottfried, is a key cause of premenstrual syndrome (PMS). The 30-something decade is also fraught with other hormonal fluctuations, she explained, such as thyroid irregularity, which can cause weight gain, depression, hair loss and GI (gastrointestinal) issues like constipation. Estrogen decline is felt also by low mood and lower libido, and lower testosterone can also impact libido, as well as cause fatigue, poor sleep and weight gain. An increase in the hormone cortisol “may make women feel tired but wired, and prompts the body to store fuel in places it can be used easily, as fat, such as in the waist.”

During this time, women do not generally consider their hormones as causing these annoyances. Michelle Violi, PharmD, dispensing pharmacists manager of the Wisconsin-based Women’s International Pharmacy, Inc., emphasized, “Some women may think they don’t have to consider hormonal balance until they reach menopause; however, hormones also play an important role in a woman’s health prior to menopause.”

When women enter their 40s, the idea of hormonally induced discomforts emerges and they realize that sometime during this decade, the first symptoms of peri-menopause will strike. Dr. Gottfried noted that during this time, progesterone declines as well as ripe eggs, and the body becomes more resistant to estrogen, inducing higher levels. These concurrent actions lead to irregular periods, moodiness and irritability, lower libido, memory issues and weight-loss resistance. Further, testosterone begins to decline, leading to loss of muscle mass while fat mass increases.

Throughout the 40s, women often deal with PMS—disrupting quality of life, and those symptoms include tension, moodiness/irritability, breast tenderness, bloating, cramping, cravings, fatigue. Violi noted that during this phase—the two weeks prior to start of menstruation, progesterone declines and may be linked to mood due to changes in GABA (a calming neurotransmitter) activity. Additionally, low thyroid function occurs with greater than expected frequency in women with PMS.

“Painful periods (primary dysmenorrhea, or dysmenorrhea without a secondary underlying cause), is thought to be caused by excessive levels of prostaglandins, hormones that make the uterus contract during menstruation and childbirth,” she explained. “Dysmenorrhea is most often treated with drugs that decrease the level of prostaglandins in the body, but hormones may still play a role.” She pointed out the results of one study looked at hormone levels in women with dysmenorrhea and compared them to women without. The researchers found that women with dysmenorrhea had higher estradiol levels prior to ovulation, higher oxytocin levels during menstruation and lower vasopressin levels during menstruation compared to women without dysmenorrhea.

Christophe Merville, D. Pharm, director of education and pharmacy development for Pennsylvania-based Boiron USA said, “Menstrual pain is the most common gynecological complaint of women and the main cause of women missing work, school, and other activities; approximately 140 million working hours are lost annually because of menstrual pain.” Approximately 40 percent of adult females contend with menstrual pain, and for 10 percent, the pain is so intense, they feel incapacitated for one to three days each month. Women are choosing to have children a little later in life, and it is no longer uncommon for this to occur in the 40s. Of course, during this decade, fertility is not as powerful, but fertility issues can also exist in one’s 20s and 30s when the biological clock is ticking loudly. Infertility is an extremely complex issue, but addressing hormonal health first (along with checking diet, stress, lifestyle and discussing the concept of counseling) would be a sound first step prior to referring to a fertility specialist.

According to Violi, low thyroid function can affect fertility due to menstrual cycles without ovulation, insufficient progesterone levels (luteal phase defect), increased prolactin levels and sex hormone imbalances. “Studies have shown progesterone can reduce the rate of pre-term birth in certain individuals,” she noted. “Progesterone is used in patients who experience recurrent miscarriages due to luteal phase deficiency (LPD), a condition of insufficient progesterone exposure to maintain a normal secretory endometrium and allow for normal embryo implantation and growth.”

Prudence Hall, MD, founder and director of The Hall Center, California, stated that “optimal fertility is obtained by balancing hormones.” She recommends 5-10 mg DHEA and 10-12 mg iodine along with a healthy diet (limit grains, gluten, sugar) that includes organic protein sources. Other recommendations she said that practitioners can make to their clients/patients who want to get pregnant include “monitoring and limiting stress (with such tools as the WellBe bracelet) and getting lots of rest. I am not a fan of the birth control pill because it side effects for some time after use limit fertility. One may need at least three years after taking the pill to conceive which is very frustrating. I always recommend that my patients use alternatives such as an IUD, diaphragm and condoms,” Dr. Hall related.

In women in their 50s, testosterone continues to decline, and at this time too, insulin levels rise by 10 points per decade starting around age 50, noted Dr. Gottfried. “The average age for menopause is about age 51, and that can be an important initiation. Focus turns on how to prevent breast cancer and the other frightening conditions that come with age. At this point, women notice that they are really aging—they see wrinkles on their face, they struggle with vision, they lose more muscle mass, they ache and they get depressed. Note that half of people with depression have high cortisol, and 20 percent have low thyroid function. Most women who come to see me are looking for improved energy (91 percent), weight loss (80 percent), help with sex drive (80 percent) and mood support (69 percent), and wonder if bioidentical hormones are a good choice for them,” she related.

There are at least three hormonal changes in perimenopause, according to Violi. The first is higher estrogen levels, followed by lower progesterone levels with less time between periods and missed ovulation, and the final change “involves disruption of a hormonal feedback system in the body known as the hypothalamic-pituitary-ovarian feedback system. Follicle stimulating hormone (FSH) and luteinizing hormone (LH) levels are affected which further contributes to higher estradiol and lower progesterone levels.”

Many allopaths and gynecologists like to prescribe hormone-replacement pharmaceuticals, such as the popular PremPro. However, one look at the bevy of common side effects is often enough for many busy women to say, “Is there anything that can help without those potential quality of life killers?”

Holly Lucille, ND, RN noted, that “Every woman enters this life phase differently, but a few key things that will help in the beginning are to eat a whole foods diet high in fruits, vegetables, whole grains and legumes. Flaxseed and fermented phytoestrogen foods such as tempeh are very good. Also, reduce intake of animal fats and dairy; the latter should be clean organic low-fat, and incorporating regular weight-bearing and aerobic exercise helps lessen symptoms.”

Dr. Hall asserted she does not like PremPro and has never recommended it. Instead, she said, she likes to recommend magnesium, melatonin and her sleep-promotion formula, Body Software Sweet Sleep, because insomnia is one of the most prevalent complaints for which peri-menopausal women seek help. Another common complaint is depressed mood, so she advises her Body Software Bliss formula and iodine (10 to 12 mg), which tends to deplete more easily during peri-menopause. “I also tell women that it is important to keep stress at bay through meditation, yoga and stress monitoring devices such as the WellBe,” she commented, adding that her dietary advice includes no grains or sugar.”

Dr. Gottfried recommends paced deep breathing for 20 minutes twice a day may cut flashes by 44 percent! Acupuncture has been shown to reduce hot flashes and night sweats. Supplements she said have been shown to reduce hot flashes in clinical trials include vitamin E, rhubarb and pollen extract (Femal).

She also likes maca, an herb that “helps with a variety of issues associated with hormonal imbalance, such as menstrual irregularities, enhancing fertility, menopause symptoms and impotence. It increases estradiol in menopausal women, and helps with insomnia, depression, memory, concentration, energy, hot flashes and vaginal dryness, as well as improved body mass index and bone density.”

Dr. Lucille likes to recommend bioflavonoids such as rutin and quercetin, vitamin B6 (for mood, supporting serotonin), evening primrose oil, gamma oryzanol and vitamin E for alleviating hot flashes, Ginkgo biloba to support against brain fog, licorice for adrenal support, and dong quai for overall support.

There are other complaints your women clients/patients may present to you for solutions. Embarrassing problems may emerge due to hormonal imbalances as well. According to Natalie Lamb, technical advisor, Bio-Kult (Protexin) explained, “Estrogen is known to stimulate the proliferation of lactobacillus in the vagina, so it is not surprising that hormonal variations can affect microflora balance in women throughout their lives. The predominance of lactobacilli in the vagina is known to create an acidic environment that protects women from infection, and its absence is the specific feature in common women’s conditions such as bacterial vaginosis, candida and UTIs.”

Women of all ages are indeed experiencing more tumultuous times because of hormonal fluctuations today than their mothers and grandmothers experienced. Dr. Gottfried pointed to several reasons, notably the modern fast-paced, always-connected digital world, being more “on” than “off.” Endocrine disruptors (toxins that affect hormones and their activities) have been shown to interfere with the production, transportation and metabolism of most hormones.

Slow metabolism (which leads to weight gain and stubborn stomach fat) is also caused by hormones, notably cortisol—and more women are fighting the cortisol balance due to more stressful lives combined with endocrine disruptors. Cortisol is the key stress hormone that also has a primary role in creating cravings, and disrupting sleep/wake patterns. “It’s basically a downward spiral,” described Dr. Gottfried. “When you get stressed, cortisol rises, you overeat, you drink coffee, cortisol rises higher, and then you get fat. Stress makes most women become hypervigilant and causes sleep troubles. Coffee, excess cortisol, and even cortisol resistance are the most common hormonal reasons for slow metabolism in women.”

Supplement Options

Several manufacturers have products you can confidently recommend to women who want hormonal balancing support.

For your clients/patients who feel their PMS symptoms are getting in the way, Connecticut-based Vital Nutrients offers PMS Support and Vitex 750 to help support endogenous progesterone production in the second half of the menstrual cycle, to balance high estrogen levels (estrogen dominance), help reduce PMS symptoms, and support regular ovulation and menstrual cycles, described Beth Baldwin-Lien, ND, director of medical affairs and education. “Vitex appears to act on the hypothalamic-pituitary axis, while vitamin B6 in PMS Support encourages healthy estrogen metabolism, wild yam has anti-spasmodic properties and passionflower is a calming herb,” she said.

For women who need ovarian support, Vital Nutrients’ d-Pinitol or Inositol Powder have been shown to support regular menstrual cycles and ovulation, by improving insulin sensitivity.

Homeopathic solutions are available for women dealing with menstrual discomforts. Cyclease Cramp from Boiron, said Dr. Merville, provides targeted relief of symptoms associated with menstruation over the choice of general pain relievers. It combines three homeopathic medicines to target cramps improved by lying down, bending over and by warmth. Cyclease Cramp is free of general allover pain ingredients such as aspirin, ibuprofen, naproxen sodium and acetaminophen, which are commonly found in many medications for cramps and PMS and therefore lower the risk of an upset the stomach, allergic reaction, dependency or overdose.

Boiron’s Cyclease PMS combines three homeopathic medicines that work on a range of symptoms including aches, lower back pain, bloating as well as irritability. “Because it works on a variety of symptoms without causing side effects, Cyclease PMS makes it easier for women to find relief in one convenient product,” Dr. Merville said.

It is free of stimulants, such as caffeine (used as a diuretic to help with water retention) and sedatives. “There is no reason to monitor caffeine consumption,” he asserted. “Cyclease can be taken day or night with no risk of causing sleeplessness, nervousness or drowsiness.”

Older women experiencing peri-menopause symptoms and who want natural relief may find it in several supplements. Patient One MenoCool, from Patient One MediNutritionals, New York, is a multi-function, natural women’s wellness formula designed to promote climateric comfort and healthy mood during menopause, according to company Vice President Kathy McIntee. “Science shows that phytoestrogens can help reduce the incidence and duration of hot flashes and night sweats and may help with the discomfort of other menopausal symptoms,” she emphasized.

MenoCool’s soy-free isofavones exert a mildly estrogenic effect, helping to optimize estrogen pathways and receptors for ideal hormonal balance, she added. Phytoestrogens, adaptogens, triterpene glycosides from black cohosh, and gamma-linolenic acid from evening primrose oil are included in the supplement to support healthy, stable mood, sustained mental clarity and whole-body comfort. Patient One recommends your clients/patients start with a “loading dose” of MenoCool during the first week and then be consistent in taking MenoCool for optimal effects.

Vital Nutrients Menopause Support formula and Black Cohosh Extract can provide adaptogenic support for women during perimenopause and help alleviate hot flashes and other common symptoms, according to Dr. Baldwin-Lien. The Sage and Ginkgo biloba in Menopause Support help provide mood and cognitive support.

According to Dr. Merville, menopausal and premenopausal women, who do not qualify for hormonal therapy or can’t take phytoestrogens may find hot flash relief with Boiron’s Acteane. The hormone-free, soy-free homeopathic medicine “reduces the intensity and frequency of hot flashes, as shown in a randomized, double-blind, placebo-controlled clinical study,” he stated. “These quick-dissolving tablets temporarily relieve the profuse sweating, throbbing headache, occasional sleeplessness, and flushed face associated with hot flashes. For best results, we recommend daily use for a period of three months.”

Candida and UTIs are often issues women encounter, which dramatically reduce comfort and quality of life during outbreaks. For the former, said Lamb, Bio-Kult Candéa is a multi-strain probiotic supplement with added garlic and grapefruit extract. Taken daily it could help strengthen the body’s natural defenses against candida overgrowth and may help to prevent its alteration from its yeast-like form to the invasive filamentous fungus form. Bio-Kult Candéa contains seven strains of probiotics to reinforce the gut microflora, helping to prevent Candida from finding sites in the gut to grow. They also lower the gut pH so that Candida, which prefers a more alkaline environment, cannot thrive. Garlic and grapefruit extract are both well-known natural antifungals. These are also shown to be compatible with the probiotic bacteria in Bio-Kult Candéa.

For the latter, Lamb noted, Bio-Kult Pro-Cyan works with the body to help maintain normal levels of bacteria in the gut for maintaining a healthy urinary tract. Pro-Cyan contains cranberry extract standardized to for a minimum of 36 mg proanthocyanidins (A-type), “known to restrict the adhesion ability of pathogenic bacteria,” she emphasized. “Pro-Cyan also contains two specifically selected probiotic strains and vitamin A, which contributes to the normal function of the immune system and the maintenance of mucous membranes.”

For women prone to urinary tract infections, Vital Nutrients offers Mannose Powder, which, said Dr. Baldwin-Lien, can be taken as either ongoing as a preventive measure or at the first sign of symptoms. D-Mannose is monosaccharide found in foods such as cranberries that can bind to pathogenic flora and prevent them from adhering to the epithelium of the urinary tract.

Performing a high-wire act requires tremendous balance from years of training and natural talent, not to mention no fear of heights—and this is why very few people in the world can do it. For women, healthy hormonal balance shouldn’t be so tricky or difficult to achieve.

For More Information:
Bio-Kult, www.bio-kult.com
Boiron USA, www.boironusa.com
Patient One Formulas, www.patientoneformulas.com
Vital Nutrients, www.vitalnutrients.net