Hormones and the menopause

‘The fact that complex behavioural patterns can be triggered by a tiny concentration of molecules coursing through the bloodstream, and that different animals of the same species generate different amounts to of these hormones, is something worth thinking about when it’s time to judge such matters as free will, individual responsibility, and law and order.’ Carl Sagan

Hormone levels are different in each of us - they ebb and flow according to your age, your health and what is going on in your life and environment. And these hormone tides move differently in men and women. In general, the four main sex hormones, oestrogen, testosterone, progesterone and DHEA, reduce in quantity over the different stages of your life and at menopause some of them stop being produced at all. Menopause is the time when hormone shifts come to the fore of our awareness because the effects of having less of them can trigger so many physical and mental problems, and we all, men and women, experience those changes to varying degrees.

Exhausted all the time? Joint and muscle pains? Terrible mood swings and rushes of anger, anxiety or depression that you never used to fall prey to? Do you sometimes feel entirely out of balance or control?

Male or female, menopause affects each of us individually, with only a lucky few not affected at all. One size prescription does not fit all, so it’s vital to understand your current personal hormone levels before deciding on how to treat it.

First, establish your hormone baseline, and then you can track symptom changes and improvements - or lack of them - going forward. Visit your GP for advice, but I would urge you to always get a couple more opinions - from a bio-identical hormone specialist, a naturopath, medical herbalist or nutritionist. Each will have their own suggestions for hormone health and a pathway back to balance. The question of hormone replacement therapy (HRT) is far too important a decision to make in any kind of unconsidered rush.

What do the sex hormones do?

Oestrogen

Oestrogen is the main ‘female’ hormone and the one we all hear the most about: women because it’s essential to our sexual health, and men because it seems to feature in an inordinate amount of their jokes!

Oestrogen helps to keep your reproductive organs healthy and the vagina elastic, lubricated and well supplied with blood. As you approach menopause, your natural levels begin to fluctuate irregularly and once your last period has passed, production stops entirely. Lack of oestrogen can lead to hot flushes, tiredness, night sweats, vaginal dryness and lack of libido. But low levels can also affect your bone density, your muscle strength, your body temperature and your sleep. If you have mood swings and are more anxious and depressed than in the past, low oestrogen may be part of your problem.

Oestrogen is, however, an umbrella term that covers three different types of oestrogen, all of which are made naturally by the body and, for optimal wellbeing, need to be kept in balance.

E1 Estrone

Estrone levels are high in teenage girls and estrone is one of the reasons they are often moody and bad-tempered. It is produced by their ovaries and in the fat cells, and high levels can cause sugar cravings and weight gain. It is the reason for their inability to wake up in the mornings and an imbalance can also lead to heavy periods, spotting and irregular bleeding. Estrone levels also rise after menopause and are associated with a higher cancer risk. For that reason, if you take the bio-identical hormone route, you are unlikely to be offered estrone.

E2 Estradiol

This is the strongest of the three oestrogens, and is the most often used by hormone specialists to get rid of the hot flushes and night sweats so often experienced during menopause. It boosts libido, is good for the brain and also keeps your bones strong. So what’s not to immediately sign up for? Again, it depends on the dosage and how your individual body reacts, but many women report weight gain - as much as 8lbs on average - and certainly, as I found out when I experimented with it, it can swell your breasts and make them horribly tender. It also affects some people’s moods, and who wants to feel like crying 24/7? Or be snappy, anxious and feel just like you used to as a teenager immediately before your period?!

Estradiol is also associated with an increased risk of certain cancers. So think carefully here. The best way to balance it is to take estriol alongside it. I came to the conclusion that anti-ageing or not, as I had no menopausal symptoms, there was absolutely no point in experiencing its side effects. If your menopause is, however, ruining your day to day life, then it’s certainly worth experimenting. You can always, as I did, throw the tube in the bin after a few weeks.

E3 Estriol

This is the gentlest of the three oestrogens, and unless you are pregnant, is found in nearly undetectable amounts in your body. During pregnancy, however, it becomes one of the highest circulating oestrogens and is made in large quantities by the placenta. Unlike estrone and estradiol it is not secreted by your ovaries, but is synthesised in the liver.

Estriol is great for your skin, for collagen and hydration and reducing wrinkles. It is the one to use for vaginal dryness and pain during intercourse, those difficult to deal with menopausal side effects.

Testosterone

‘By the end of puberty testosterone levels in males are 8 to 10 times higher than in females, but decrease with age...’ James McBride

This is the John Wayne of hormones, the one that ‘makes men men’. It’s produced in their testes, and high levels are associated with self-confidence, energy and positivity. It’s important for libido, muscle strength, red blood cell production and bone density. The multitude of issues that arise when women ‘hit’ menopause, is common knowledge but less openly discussed is the possibility of a ‘male menopause’, the result of a similar fall in hormone levels and particularly of testosterone, which declines as older age approaches. Men can suffer from erectile dysfunction, weight gain and body hair loss. Usually by the age of 60 testosterone levels have dropped substantially and in 4 out of 10 men, problems set in after the age of 45.

But women need testosterone too, although we produce a tenth of the amount of men. Testosterone in women is made by the ovaries and by the adrenals, which keep producing low amounts even after menopause has caused a halt to oestrogen production. Testosterone is responsible for our libido levels too, as well as for the amounts of oestrogen produced and for the balance of hormones overall. During pregnancy, it is testosterone that determines whether your baby is a boy. Strong hair growth in either men or women is usually linked to the amount of testosterone present, and a fall in your levels may lead to muscle loss, osteoporosis, lack of sex drive, sagging lustreless skin and lowering of mood. Tiredness and overall exhaustion is another sign that your testosterone levels may be falling.

Progesterone

Progesterone is regularly produced in women during the second half of their cycle and also produced in the placenta during pregnancy where it gets the uterus lining ready for the implantation of a fertilised egg and supports the embryo throughout the gestation period. If you suffer from heavy periods, mood swings and headaches, think low progesterone and consider bio-identical supplementation at a professional clinic. Low progesterone is linked to endometriosis, infertility and post-natal depression. If you suffer from PMT or are regularly missing your periods get your levels checked - it may be lack of progesterone that’s part of the problem.

When your periods stop altogether, so does your progesterone production and here you need to pay attention. This is the one you need topping up if you are struggling with hot flushes or low libido or if you are always tired and suffering from depression or mood swings. It reduces high cholesterol, boosts the thyroid and regulates blood sugar levels. It also protects you from endometrial cancer.

DHEA

DHEA is the hormone that boosts your energy levels and strengthens your immunity. It is the one that keeps you looking younger than your friends and neighbours and keeps you happy and healthy into your older age. It boosts libido and improves memory and both protects against diabetes and reduces joint pain. It is mainly made by your adrenals, though the testes and ovaries also produce smaller amounts. It is a precursor to both oestrogen and testosterone, which means that it can convert into either whenever one or the other is needed so can act as a ‘top up tank’. After the age of 30 DHEA starts declining by around 2% a year. I worked that one out - by the time you are 60 you will have 54 % of your original allocation. Ten years later only 45% and by the age of 80 a residual 36%. Sounds like a sensible one to talk to a professional about….

Think before you take any supplementing steps

The decision of whether to supplement with pharmaceutical hormones, bio-identical hormones or another similar alternative is entirely up to you. Do not be persuaded or brow-beaten by anyone until you have taken the time to research the topic for yourself.

To replace or not to replace? A modern day question

It all sounds great. Just manipulate your hormone levels, push them back to the levels of your younger days and age fabulously in the process. Who wouldn’t want a magic cream that delivered oestrogen levels the same as they used to be when you were younger? Or to pop a suitable hormone pill every morning? It’s the Holy Grail of Older Age. Bring it on....

But studies consistently flag a different story. Even women who have naturally higher levels of estradiol and estrone in their bodies develop breast cancer more often than women with lower levels of estrogens. Breast tissue from women with breast cancer has been shown to contain higher levels of estriol, estrone and estradiol than tissue from women without breast cancer. Endometrial cancer is flagged as a potential ‘side effect’ of using estriol and uterine cancer is similarly linked to estradiol. And that’s just the oestrogens… The pluses all seem to come with minuses: the wonderful side effects balanced by serious nasties.

I read somewhere that ‘No risk-free hormone has ever been identified’ and I don’t think we can be certain that playing around with hormones doesn’t come with an additional cancer risk, whatever anyone may tell you.

So I would always do your homework carefully and if you do decide the hormone route is for you, then use it as a tool to carry you through a bad patch, rather than as a prescription for life.

 
 

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Written by health advocate Sara Davenport, founder of one of the UK's leading breast cancer charities, Breast Cancer Haven. With over twenty years' experience in holistic health, Sara's digital dose of wellness teaches you to listen to your body, tweak your lifestyle and improve your health. 

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