“My hormones are out of whack!” That’s the single most common sentence I hear from my patients.
It can come from a 25-year-old with irregular periods and industrial-strength PMS whose energy has gone down the tubes. Or from a 45-year-old (on the threshold of pre-menopause) who continues to gain weight even though she’s eating less and exercising more, and who adds that her brain feels like mush and her sex drive is a distant memory.
Many of my current patients have previously seen other doctors and were given prescriptions for hormones to “cure” these ills. Hormones came in the form of birth control pills or hormone replacement therapy (Premarin). Sometimes an antidepressant was thrown in for good measure.
This is definitely and categorically the wrong approach.
Let’s start with a few facts:
• Hormones are immensely powerful molecules The cells in your body have specific receptor sites for each of them. To give you an idea how potent hormones are, current birth control pills and thyroid replacement are both dosed in micrograms (that’s 1/1,000,000 of a gram). The active ingredient in a birth control pill is invisible to the naked eye.
• Unlike a man’s testosterone, your estrogen and progesterone levels change constantly, and you feel these changes. This continues after menopause even though you may not have enough hormone to trigger a menstrual period.
• Hormones definitely affect how you feel day to day in a variety of ways, and when they’re out of balance, you can feel pretty crummy. However, since imbalance isn’t a disease, your routine blood tests will be normal.
• Sex hormones and stress-buffering serotonin are closely linked, like two cars of a roller coaster. When your estrogen falls (as it does during PMS or pre-menopause/menopause), it pulls feel-good serotonin down with it. This can cause you to cry at a Hallmark commercial or snark at your loved one.
• Imbalance of thyroid and adrenal hormones are often involved too. There’s no actual disease, but rather “fatigue” of these glands. One symptom of thyroid and/or adrenal fatigue is (you guessed it) fatigue.
• Your sex hormones are very much affected by lifestyle choices: primarily diet, exercise, and stress levels.
• Hormone imbalances can be corrected without prescription drugs.
Measuring hormone levels
First let’s discuss a strategy to get your health insurance to pay for as much of this testing as your policy allows. Good hormone testing is pricey. (Those $30 kits that test all your hormones are only moderately accurate, especially when it comes to estrogen and progesterone. If you’re having periods, levels of these hormones change virtually every day, and trying to get an accurate picture with a single day’s result is a waste of your money.)
The best way to get your doctor to sign off on hormone tests is to arrive prepared, knowing what you want, and being able to counter a response like “You don’t need those tests.” This would be your opportunity to say something like (obviously you’ll describe your own symptoms) “I’m miserable and all my other tests are normal. I’m tired and cold, gaining weight, and my periods are a mess. Believe me, women know their hormones.”
Doctors are almost always in a hurry and since your doc’s not paying for the tests, she may capitulate to your request rather than argue. Your doctor can order most of the following tests from whatever lab she regularly uses. The nurse will draw your blood and your doctor will receive the results in a few days.
If you’re a WholeHealth Chicago patient, just contact one of our assistants to schedule a lab-only appointment for drawing blood. This won’t require a visit until after your test results are back.
Thyroid hormone testing Low levels of thyroid hormone (called hypothyroidism) are extremely common, causing fatigue, puffy facial features, a sense of feeling cold, dry skin and hair, weight gain, and irregular periods. Consider low thyroid especially if thyroid problems run in your family. Ask your doctor for these tests: TSH (thyroid stimulating hormone), free T-3, free T-4.
Adrenal hormone testing Definitely under-appreciated by many physicians as a cause of chronic symptoms, especially fatigue, “crashing” in the late afternoon, salt cravings, and low blood pressure. Ask your doctor for these tests: DHEA, AM and PM cortisol levels.
Sex hormones testing If you’re in your late thirties, early forties, or beyond AND your periods are becoming irregular, two hormones produced by the pituitary (the master gland) are measured to determine if you’re entering menopause. Ask your doctor for these simple blood tests: FSH (follicle stimulating hormone) and LH (luteinizing hormone).
If you’re menstruating, the best test measures your hormone levels throughout a single cycle. The “Female Hormone Panel” by Genova Diagnostics supplies you with a take-home kit containing ten plastic vials to collect specimens of saliva over a period of one month. When you FedEx the kit back to the lab, they’ll measure your levels of estrogen, progesterone, and testosterone, and graph the results for you. Your doctor can order the kit here.
She may prefer to test your blood for these hormones. This requires returning to the office at least three or four times over a month to have your blood drawn at appropriate intervals.
Remember: if you have chronic symptoms and your doctor tells you everything is fine, the problem is probably a hormone imbalance. But you already knew that, didn’t you?
Drug-free hormone balancing
You yourself can balance your sex hormones–estrogen, progesterone, and testosterone–by making some key lifestyle choices.
Taking these steps will also help you look and feel spectacular (exercise, good foods, and supplements really do work):
- Exercise every day Walking is fine. Whatever exercise you do, do it outdoors in the sunlight whenever possible.
- Eat a high-fiber diet including flaxseed, whole bran, beans, seeds, veggies, and fruits. These foods will actually improve your estrogen levels.
- Dramatically reduce/eliminate the amount of sugar you eat, including all forms of sugar and also high-glycemic foods, which rapidly convert to sugar. These are foods like potato chips and refined white-flour bread, pastries, and pasta.
- Eat more cruciferous vegetables such as broccoli, Brussels sprouts, and cabbage. These contain a substance called indole-3-carbinol that converts potentially cancer-causing estrogen to a form of estrogen that actually protects your breasts.
- If you eat a lot of grapefruit, stop doing so and limit yourself to once or twice per month. Research shows grapefruit blocks estrogen metabolism and actually increases the risk of breast cancer.
- Choose mostly organic produce, dairy, and meats (and wild-caught fish) to avoid exposure to chemicals, foreign estrogens, and antibiotics.
- Use filtered water (reverse osmosis) to avoid estrogen in the water.
- Increase your omega 3 intake by regularly eating cold-water fish and flaxseed oil, or by taking fish oil supplements.
The most useful daily supplements to help you balance your hormones:
If you are menstruating:
If you are in the menopause transition:
David Edelberg, MD