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Menopause is not a pause. While menopause literally means "cessation of menstrual periods," for most women it defines the most traumatic part of their lives. It forces them to confront the inevitability of aging. It is not a glorious transition; it is not a time when women feel free and empowered.
As one of my patients put it, "The menopausal experience changes one's sense of self. Lots of little things go wrong and then suddenly, one day, you find you are not the same person anymore." It is the accumulation of many symptoms and changes that become progressively less manageable and end up all too often with disastrous consequences. These disastrous consequences affect more than forty-three million women today, along with twenty-one million women who will be reaching their menopausal years in the next decade. The research on menopause is limited, solutions scarce, information contradictory. In 1993, the National Institutes of Health started a ten-year study to compare hormone replacement therapy with diet, exercise, and calcium supplementation in the prevention of cancer, heart disease, and osteoporosis. The results of this study will not be available until 2005 at the earliest. Who has time to wait until then? Definitely not the millions of women suffering from symptoms of hormone imbalance today. Those women have options; all they need is an understanding that menopause is simply another change -- it does not happen overnight -- it's another transition in the continuum of change in our lives.
Indeed, long before we reach the point of being overwhelmed by the symptoms of menopause, long before we feel totally betrayed by our bodies, little by little, onesymptom at a time, menopause unfolds over more than thirty years. The key to preventing the serious and devastating problems created by menopause is found in understanding the correlation between these symptoms we experience at all times during our lives and the hormone imbalance that causes them. The symptoms begin when we are in our teens, and they follow us throughout our lives with incredible tenacity. Let's look back in time and see when they begin and what causes them to occur. Once we realize that these symptoms are part of our lives at all ages, we can uncover their root cause. If we connect our symptoms to the particular type of hormone imbalance that causes them -- regardless of age -- then we can treat the problem and prevent it from recurring or getting worse. In The Hormone Solution, I'll provide you with a comprehensive solution for the treatment of the normal changes that affect women (and men) throughout their lives.
Does the following sound familiar? You're thirteen. You are an accomplished athlete and a tomboy. You refuse to wear dresses even when you go to church. Your mother is concerned because all your friends have gotten their periods while you show no signs -- no breast buds, no perspiration odor, no pubic hair. Your mother takes you to the doctor, and your blood tests, physical examination, and CT brain scan are normal. Nothing changes for another three years. And then, over a period of six months, you become a girl -- you stop being a tomboy, you grow breasts, get your period, and start blushing when you meet a boy.
Or maybe this rings a bell? You're twenty-four. You just had your second child. The pregnancy was uneventful, and your baby is beautiful and healthy. Although you have plenty of support from your family and friends, you're getting depressed. With each passing day, your family helplessly watches you lose interest in the baby and yourself. You finally give in to your husband's pleas to go see a doctor. You're diagnosed with postpartum depression.
Perhaps you're at a later stage: You remember when you were thirty-two and would come home from work and finally finish with the husband, the kids, and the phone calls. Those were the days when you were done with another long but rewarding day and couldn't wait to hit the sack. You'd crawl into bed and fall asleep within a minute. You slept as if you were in a coma. Now, fifteen years later, you're forty-seven. Your job is secure, your kids have their driver's licenses and are ready to go to college, your husband and you have stopped bickering over the position of the toilet seat cover, and just when you thought things should be getting easier, something very strange has happened.
By 10 p.m., you are so exhausted you barely make it through brushing your teeth and applying your five different antiwrinkle creams guaranteed to take ten years off your face. You're extremely tired but you dread getting into bed because you know what follows will be a torture you never believed possible. And yet, you have no choice, you know you need the rest. So you go to bed, and thankfully, you fall asleep: but not for long. Suddenly, it feels as though a bolt of lightning has shot through you. You jump up, it's 2 a.m., you're lying in a pool of sweat, and your body temperature feels high enough to boil water. The sheets are twisted around you; your heart is pounding hard. You're fairly sure you aren't having a heart attack because the same thing has happened every night for months now. Suddenly, you realize you have to pee so badly that you're not sure you can make it to the bathroom. Holding on to the walls, you reach the toilet and pray this activity won't wake you up too much. You return to bed and pull the blanket to your nose as a cold shiver runs through your body. You close your eyes and try not to think of the perspiration-soaked sheets, which have now turned to ice. You look around and wonder why the man lying next to you is sleeping soundly. You lie awake for hours desperately wanting and needing to sleep. When the alarm goes off in the morning, you want to die. You cannot believe it's time to start another day feeling this way.
What happened? What has changed between the time you were thirteen and forty-seven?
The answer is simple: Your hormones. Let's assume that our lives are a jigsaw puzzle. The pieces that make up the puzzle are our hormones. Having all the pieces isn't enough. What we must know is how the pieces fit and, once they do, how to keep the puzzle together. When you're thirteen, you clearly lived in a world where the puzzle fits neatly and flawlessly. While your hormones may not follow the expected mold—breast buds at eleven, menstruation at thirteen -- you're fine. Your hormones balance themselves and find the happy medium to keep you healthy and normal. At twenty-four, postpartum depression represents a common example of hormone imbalance of a more severe type. By forty-seven, the problems appear insurmountable. Our hormones, the pieces of the puzzle, begin to come apart, and we either figure out how to fit them together again, or we become sick, we feel old.
The Hormone Solution will teach you how to identify each piece of the puzzle, make the pieces fit, and give you the secret to keeping the puzzle intact for years to come. I will give you the background you need to build the foundation that keeps your body and mind in perfect balance. If you understand how your body works, you can help forestall illness, get rid of unwanted symptoms, and restore your energy and vitality.
This may sound like a tall order, but I promise you it's not. I won't waste your time with intricate, medical detail. While understanding the complex physiology of hormones may be interesting, it's their application to our personal lives that really matters.
Hormones are products of living cells that circulate in our bodily fluids and produce specific effects on the activity of other cells far removed from the organs where the hormones are made. They stimulate or inhibit the actions of cells everywhere in the body. No organ is left untouched by the actions of hormones. Hormones, however, cannot be seen with the naked eye, and this situation makes them very difficult to understand.
Endocrinology: The Study of Hormones
In the 1970s, when I went to medical school, endocrinology, the medical subspecialty involved in the diagnosis and treatment of diseases of hormones and the glands that make them, was not a popular course. It was complicated, it dealt with intangibles, and few students could grasp it. Hormones were complex structures, critical to the proper function of the human body, yet impossible to pin down. Even when dealing with diseases, they were difficult to evaluate by our medical testing methods. Everywhere you turned, be it in illness or in health, you saw their effects on men and women, yet our profession could not control them.
Blood tests were inadequate and cumbersome, and no radiologic techniques for evaluating the actions of hormones existed. Testing pituitary (master gland) function was hell for both patient and physician. We tested only for disease. The tests were complicated, they took days to perform, the patients were invariably very sick, and the results were difficult to interpret. Laboratory and clinical research was intricate and laborious, and the information published in the scientific literature was mostly esoteric, pertaining mainly to animals and not humans. As a result, few medical students chose endocrinology as their career.
Even now, endocrinology, with its focus on disease -- diabetes, thyroid, pituitary, and genetic hormone imbalances -- is not a popular specialty. There has never been a glut of endocrinologists, which very well may be the reason why the study of hormones and how to balance them has become an area for wellness experts and anti-aging specialists.
The Importance of Hormones
Hormones run through our bodies with great speed. They have the power to make us feel well, but they can also wreck our lives. There are many types of hormones, all with important roles in keeping us balanced and healthy. They balance our sugar level, instruct our cells to generate energy, keep our calcium level normal and our hearts beating regularly, and help our liver detoxify our system even after a five-martini night. Even with twenty-six years of clinical medical experience and my present focus on the study of hormones, I am still utterly fascinated by their impact on the human body. Although there are a lot of known hormones controlling our body's functions, I believe one particular hormone group reigns supreme: the sex hormones. These are estrogen, progesterone, and testosterone. They determine our gender; they are responsible for our outlook on and reactions to life, how we age, and ultimately how long we live.
The Primitive Master Gland: The Hypothalamus
Hormones are produced by lots of organs, but their production and actions are always rigidly controlled by the master gland -- the hypothalamus (hi-po-THA-la-mus, a pinhead structure buried in the middle of the brain, above the pituitary gland). The hypothalamus literally supervises the synchronization of hormone release. We don't know how the hypothalamus got to be in charge of all hormone balance. Its mysterious function has been studied for many years. The most commonly accepted belief is that the hypothalamus is a very old organ linked to early animal evolution; it was allegedly there before the pituitary existed and before sexes were differentiated. Its role was to control basic body functions—heartbeat, breathing, digestion, reproduction, excretion. Throughout evolution, the hypothalamus has maintained its controlling role by making the one hormone that coordinates all sex hormones: gonadotropin-releasing hormone (GnRH).
Through a system of blood vessels inside the brain, this hormone goes directly to the pituitary and stimulates it to release its own set of hormones with the final role of modulating end-organ sexual hormone production. "End organ" refers to the ovaries, testes, and adrenal glands; the hormones they produce are estrogen, progesterone, and testosterone, among others. Remarkably, this one hormone (GnRH) monitors the production and effects of hormones made by the pituitary, the ovaries or testes, and the adrenals. This remarkable feat is the main reason why the hypothalamus is one of the key pieces in the hormone puzzle.
Along the evolutionary ladder, a new organ developed between the hypothalamus and the other organs (heart, lungs, stomach, ovaries, testes, adrenals). That organ is the pituitary.
The Modern Master Gland: The Pituitary
Below the hypothalamus, buried in the middle of the brain, lies the pituitary gland. While we consider the hypothalamus a primitive, old remnant of an antique glandular system, the pituitary is much newer -- the modern-age master gland. Arbitrarily divided by physiologists into anterior and posterior portions, the pituitary produces a lot of different hormones. All sex-hormone-releasing and -inhibiting factors are produced by the anterior portion of the pituitary gland. It is there, in an area of a few millimeters, that the headquarters of hormone regulation are located.
The anterior pituitary is in charge of stimulating or blocking the release of the principal sex hormones -- estrogen, progesterone, and testosterone. This is accomplished through the actions of two hormones secreted by the anterior pituitary: follicle-stimulating hormone (FSH) and luteinizing hormone (LH). FSH and LH are directly responsible for cycling the production of estrogen and progesterone by the organs that produce them (ovaries, adrenals, and corpus luteum). FSH stimulates estrogen production, while LH stimulates progesterone production. FSH and LH work together to balance estrogen and progesterone levels. Another sex-related hormone produced by the pituitary, prolactin is released primarily after a woman gives birth. Its role is to stimulate the breast to produce milk and to shrink the size of the uterus back to normal.
How Do FSH and LH Work?
Let's take an average twenty-eight-day menstrual cycle, when you aren't pregnant. We'll start with day 1. You have just started your period. Your estrogen and progesterone levels are practically nil. The lack of hormones in your system is what has induced you to get your period.
GnRH from the hypothalamus and FSH from the pituitary are excreted in response to the level of estrogen circulating in your bloodstream. On day 1, as the blood washes against the hypothalamus and anterior pituitary, there's practically no estrogen in it. The hypothalamus thus sends out its hormone GnRH to wake up the pituitary. The receptors on the cells that make up the anterior pituitary gland respond to the rise in GnRH and the lack of estrogen in the bloodstream. Their response is to release FSH into the bloodstream. The presence of FSH stimulates the ovaries and adrenals to start making estrogen. For the following ten days of the normal cycle, the anterior pituitary gland will be pouring out FSH to stimulate the ovaries to make estrogen.
Indirectly, the high levels of FSH -- together with the now-rising levels of estrogen -- are responsible for another important job. Remember that FSH stands for "follicle-stimulating hormone." Its job is to stimulate the formation of the follicle and the maturation of an egg. In one of the ovaries, an egg has been identified. This egg (ovum) will become mature over the following ten days. It is this egg that will be expelled from the ovary at the time of ovulation, fifteen days before the end of the cycle. If fertilized by a sperm, this is the egg that will become a baby nine months later.
FSH and estrogen prepare the egg for ovulation. This part of the cycle is called the follicular phase. It is during this phase that the ovaries are making estrogen and testosterone to help the egg ripen. As it ripens, the egg is surrounded by a protective bubble, the follicle, which develops as the egg matures. Once mature, the egg is expelled from the ovary on ovulation day. The follicle is left behind in the ovary and it becomes the corpus luteum, which produces progesterone.
As this scenario unfolds, the increased levels of estrogen produced by the ovaries and follicle are now reaching the pituitary and sending a new message to the master gland: "We have enough estrogen here to go ahead and ovulate."
If the pituitary reads the message correctly, it starts releasing LH (luteinizing hormone). LH promotes ovulation. Within ten to twelve hours of the spike of LH in your bloodstream, you ovulate. LH stimulates the production of pro-gesterone, the thinning of the wall of the ovary, the expulsion of the egg from the ovary, and the beginning of the luteal phase of the cycle. Once ovulation has occurred, fifteen days before the start of the next period, LH levels drop rapidly.
While FSH is around for the better part of the cycle, stimulating the production of estrogen and its attendant effects, LH comes out for just a short time, in spurts or pulses. LH production is turned off by the increasing levels of progesterone.
For the last two weeks of the cycle, estrogen and progesterone production are in balance to prepare the body for pregnancy.
Progesterone is made by the corpus luteum, the name given to the follicle once the egg has been expelled from the ovary. The corpus luteum then becomes an independent organ responsible for further support and preparation of the egg for fertilization. The progesterone made by the corpus luteum prevents other eggs from maturing, and keeps the uterine lining ready for implantation. More than 90 percent of the body's progesterone is made by this short-lived organ. If you get pregnant, the corpus luteum thrives and makes literally gallons of progesterone to nurture and sustain the fetus during the pregnancy. If you don't get pregnant, the corpus luteum shrinks and dies. With its demise, progesterone production -- and thus circulating progesterone levels -- wanes. The cycle has ended; you get your period. The fall of estrogen and progesterone levels is sensed by the hypothalamus. This signals the start of a new cycle, and the hypothalamus heralds it by secreting GnRH.
The cycle repeats itself every month until you either get pregnant or stop ovulating.
Today, in the arsenal of medical knowledge, there are many sex hormone precursors, multiple "almost sex" hormones, and lots of wannabe sex hormones. There are only three true end-organ sex hormones: estrogen, progesterone, and testosterone. Both men and women have all three. The difference between men and women lies in the varying concentrations of these hormones circulating in the bloodstream.
Estrogen and progesterone are the dominant hormones in women. The dominant hormone in men is testosterone. A significant shortcoming in our understanding of hormones is the belief that estrogen, progesterone, and testosterone act independently of one another. The truth is that unless we totally incorporate into our understanding the inseparability of the three sex hormones, we cannot solve the problems caused by imbalances in their levels.
In women estrogen is made in the ovaries, the follicle around the ovum, the adrenal glands, and the fat cells. Estrogen is not just one molecule, but rather a group of molecules. The three main estrogen molecules are estriol, estradiol, and estrone.
When we refer to estrogen, we refer to its three components as one. At times, this attempt to simplify creates errors in separating the individual functions of its components. Although their combined actions present as one in what we know as estrogen, its component molecules have different potencies. For now, just remember that when I'm speaking of estrogen, I'm referring to all three components (estriol, estrone, estradiol) as one, unless otherwise specified. When I address treatment with natural hormones, however, I'll be separating the three estrogen molecules.
With the progression of the aging process, the ovaries stop producing estrogen on a regular basis, and the main source for the production of estrogen becomes the adrenal glands. Unused testosterone is also transformed into needed estrogen, and even estrogen stored in fat cells is called to action. Estrogen and progesterone are designed to balance each other, to keep each other in check.
We cannot live in a healthy state without their balanced presence in our bodies. As we begin to examine their individual effects, keep in mind that at no time does estrogen or progesterone act independently, in our body.
Estrogen makes everything grow. The positive effects of its action are that it:
The negative effects of the growth induced by estrogen unopposed (acting alone), without the balancing effects of progesterone, are:
Progesterone is made primarily by the corpus luteum (the follicle transformed after ovulation), and is a precursor to most sex hormones. Progesterone comes into action in the middle of the normal menstruating woman's cycle.
Stimulated by the release of LH (luteinizing hormone) in the form of pulses by the pituitary gland, progesterone is absolutely crucial to the survival of the ovum once fertilized. When pregnancy occurs, progesterone production increases rapidly and is taken over by the placenta. If the woman does not get pregnant, the corpus luteum shrinks, progesterone production falters, and menstruation arrives.
Progesterone is the precursor, or parent, of estrogen in the ovaries. The adrenal glands and testes also manufacture it. Progesterone is the precursor of testosterone, all androgens, and other adrenal hormones, making it extremely important for reasons far beyond its sex hormone role.
Progesterone's functions on the estrogen-progesterone team are to:
Progesterone's negatives are few and easily balanced by estrogen:
The classic male hormone, testosterone is the third of the sex hormone trio. Made primarily in the testes and adrenals in men, and the adrenals, ovaries, and corpus luteum in women, testosterone is part of a class of hormones called androgens. These hormones have primarily masculinizing effects. Like estrogens, when we speak of androgens (AN-dro-gens), we include more than one hormone: testosterone (tes-TOS-te-rone), androstenediol (an-dro-STENE-di-ol), dihydrotestosterone (DI-hy-dro-tes-TOS-te-rone), androstanediol (an-dro-STANE-di-ol), androstenedione (an-dro-STENE-di-own), and dihydroepiandrosterone (DHEA)(di-HY-dro-ep-i-an-dro-STER-one).
The most important role of testosterone is to provide male characteristics. Although this may appear straightforward, testosterone functions are of significance to women as well. Testosterone helps to:
The negative effects of testosterone are due to overproduction or intake through either testosterone supplementation in pharmaceutical formulations or unsupervised androgen consumption. The side effects are similar to those of estrogen dominance, since testosterone transforms into estrogen when it's overabundant. These side effects include:
We are only now starting to appreciate the importance of testosterone in men and women. While the balance of estrogen and progesterone is highly dependent on a cycle, we don't yet know how the balance of testosterone fits. As the story of hormones unfolds, I'm sure much more will come to light about testosterone.
Here, then, is the skeleton of hormone information I'll be building on.
Hormones are intimately involved in every body function. The amounts of hormones secreted are controlled by two glands in the brain -- the hypothalamus and the pituitary. Hormones are produced by the sex organs: the ovaries, testes, and adrenal glands. There are three sex hormones: estrogen, progesterone, and testosterone. Their actions are interconnected and are both positive and negative. The balance and interaction among the sex hormones determine the presence or absence of symptoms.
In the chapters that follow, I promise you insights that can change your life for the better.
Copyright © 2002 by Erika Schwartz, M.D..
|Chapter I||How Did We Get Here?||1|
|The Hormone Story||5|
|Estrogen, Progesterone, and Testosterone||11|
|Chapter II||The Theory of Hormones||19|
|The Physical Differences||19|
|How Hormones Keep Humans from Becoming an Endangered Species||21|
|Chapter III||The Symptoms of Hormone Imbalance Occur at All Ages||28|
|Symptoms of Hormone Imbalance in the Teens||29|
|Symptoms of Hormone Imbalance in the Twenties||33|
|Symptoms of Hormone Imbalance in the Thirties||38|
|Symptoms and Diseases Associated with Hormone Imbalance in the Forties and Beyond||46|
|Chapter IV||Conventional Methods of Treatment for Symptoms of Hormone Imbalance||55|
|Treatment Options: Conventional Therapies||58|
|Chapter V||Alternative Treatments for Symptoms of Hormone Imbalance||67|
|Be an Informed Consumer||68|
|Treatment Options: Alternative Therapies||73|
|Chapter VI||Natural Hormones||84|
|What Are Natural (Bioidentical) Hormones?||88|
|The Difference Between Synthetic and Natural Hormones||91|
|Natural Hormones and the Consumer||94|
|Why Hasn't Your Conventional Doctor Told You About Natural Hormones?||95|
|Natural Hormones Are the Solution||97|
|How Can You Get Natural Hormones?||100|
|Chapter VII||The Hormone Solution Program and Dosage Guidelines||103|
|Methods of Natural Hormone Administration||106|
|The Hormone Supplementation Program||107|
|Long-Term Use of Natural Hormone Supplementation||116|
|Chapter VIII||Clearing Up the Confusion About Medical Testing||118|
|Twenty-Four-Hour Urine Testing||126|
|Cardiac Stress Testing||128|
|Pelvic Ultrasound: The Best Way to Follow the Effects of Hormone Treatment||130|
|CAT Scanning and MRI||132|
|Testing Regimen for Hormone Solution Patients||133|
|Chapter IX||Synthetic Hormones and Cancer||134|
|Chapter X||Diet, Exercise, and Lifestyle||156|
|Chapter XI||What About Men?||192|
|Male Hormones and Sex||198|
|Administration of Testosterone Supplementation||205|
|Available Hormone Preparations||213|
|Glossary of Terms||219|
Posted March 30, 2009
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For such a confusing subject for women, this books certainly helps the layperson that wants to better understand this complicated system in our bodies. Heard Ms. Schwartz speak on the radio and found her presentation worthy of purchasing "The Hormone Solution". I have not been disappointed and have a better understanding of the choices I want to make concerning my health and maintaining optimum balance of hormones.Was this review helpful? Yes NoThank you for your feedback. Report this reviewThank you, this review has been flagged.
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