About the Author
Tami Meraglia, MD, known as “Dr. Tami” to her patients and fans, is double board certified in integrative and natural medicine and aesthetic medicine. She is the medical director of the Vitality Medical Clinic in Seattle, Washington and serves on the advisory board of Douglas Labs, one of the largest medical grade nutraceutical companies in the United States, where she contributes to research and education.
Excerpt. © Reprinted by permission. All rights reserved.
The Hormone Secret CHAPTER 1
Hormones Working Together: The Entire Orchestra
Perk up your ears and imagine sitting next to me as the curtain is about to rise on the opening night of a concert. The orchestra consists of strings, wind, and percussion sections, each tuning up with dissonant sounds. Initially, there is a kind of chaos as orchestra members practice and refine the parts they play in the performance that’s about to begin. Yet slowly the instruments begin to work together in harmony. They become a cohesive unit as the curtain goes up, and the performance transports you. In many ways, your hormones, which control the functions of organs and tissues in your body, are similar to a philharmonic. Hormones must balance and work in concert with one another to create optimal health. In perimenopause or menopause, too little or too much of one hormone causes an imbalance in others and can set off a chain reaction of dysfunction. This imbalance is common, because our hormones rarely decline at exactly the same rate and pace.
That’s why I often hear a familiar story when a new patient comes to my office. I always ask, “Why are you here?” The answer is usually: “I’m not really sick. But I don’t have the energy I used to.” Frequently, a primary-care physician has prescribed an antidepressant or sleeping pills. I point out that the symptoms of depression and insomnia are almost identical to those of hormone imbalance. “First, let’s check to see if you have any hormone deficiencies,” I add. “Maybe we can restore hormone balance without adding prescription drugs that have a long list of side effects.” I want to know why my patients are experiencing a problem, and address that first, rather than to simply treat symptoms.
I also explain that our years of perimenopause and menopause are associated with more significant physical changes than at any other time of life, except puberty. Loss of energy is only one of the issues. Unless an MD has taken additional education in integrative medicine or anti-aging (as I have), he/she can easily miss the very real problem of hormone imbalance. Why? Because the traditional medical education that I and other physicians received focuses on diseases and how to treat them, rather than on how to create and maintain wellness.
Hormone imbalance is not a disease, but it can wreck your quality of life. We live in a society where our hormones are depleted long before the end of our life span, and at a much earlier age than was the case for our parents or grandparents. As early as our thirties, our bodies and our hormone levels are no longer in concert. The challenge is to boost some hormones to help them recalibrate and rebalance. I’m going to educate you in how to deal with and treat any hormone deficiencies you may have. It is possible to reboot your biology with a host of nutritional and lifestyle changes, plus supplementation with herbs, vitamins, and minerals available over the counter. I help women do this every day. But first I want to help you understand the state of your own hormones.
What’s Going On?
Just recently, I saw three different patients who felt desperate and didn’t know what was wrong with them. One, a single high-school English teacher, was experiencing premenstrual syndrome (PMS) for the very first time at the age of thirty-nine. She complained of cramps, headaches, and other symptoms, and she felt bewildered by this new turn of events. Another patient, forty-two years old, felt guilty about how often she kept “losing her cool,” after priding herself on being a patient, calm wife and mother. “This isn’t me,” she insisted. The third woman, forty-five, a successful business executive, was experiencing profound fatigue for no plausible reason. “I used to be a ball of energy. I don’t understand what’s happened to me,” she said.
All three women had no idea their symptoms suggested the beginning of menopause. Neither they nor their primary-care physicians had made the connection, because they didn’t have hot flashes and night sweats. Many women (and some doctors) don’t associate exhaustion, irritability, brain fog, or unexplained weight gain and other menopausal symptoms with hormones. They conclude, “I’m cranky because my life is busy. I have small kids and I work. Of course I feel crappy, because I’m not sleeping. My work is stressful. I’m not losing weight, because I’m not working out.” Some of these women are divorced. Some juggle a career and the care of elderly parents. Or they’re stay-at-home moms, contending with stresses of their own. Whatever the individual scenario, they just accept “feeling off” as a consequence of external grievances—when it’s really about internal disequilibrium that can be fixed. And the sooner the better!
What You Need to Know About Perimenopause and Menopause
People often confuse the terms “menopause,” which occurs at an average age of fifty-one in North America according to the National Institutes of Health (NIH), and “perimenopause,” the years leading up to cessation of your menses. Menopause simply means you have not had a period for twelve consecutive months. Perimenopause can start ten years before you hit the mark of menopause. You may experience perimenopausal symptoms as early as your thirties—and certainly your forties. Hot flashes and other symptoms are part of menopause, because they’re directly related to the decline and absence of the hormones estrogen and progesterone. However, it is perimenopause that really affects your quality of life. For some women, hot flashes and night sweats start in perimenopause, the period of time when hormones begin to decline but are not yet entirely absent. Other women don’t have flashes and sweats but do have mood, cognitive, weight, and other problems at this stage.
Why Is This Happening?
Your ovaries are the primary organs producing several hormones, including estrogen, progesterone, and testosterone in the childbearing years. Childbearing plays a big role in hormone levels. Pregnancy is ten months, not nine. Your ovaries and adrenal glands go into a totally different modality at this time, and hormones are different. It takes quite a while for the body to figure out how to get back to normal. For example, hair gets thick and luxurious during pregnancy. You have the same static level of estrogen and progesterone while you’re pregnant. The normal cycle of your hair growing and then falling out doesn’t occur. It just grows and stays.
After the baby is born, hair falls out because your hair has a lot to do with estrogen. Some women feel as if they’re going crazy because they see handfuls of hair in the shower.
Not everyone has lingering hormone issues after giving birth, but a large number of women do. For nearly a year, you are pregnant and your hormones are in suspended animation They don’t go through their normal rise and fall. After pregnancy our hormones rush out, and it’s like pulling out a plug. There’s nothing gentle about it, and it feels very abrupt. In some women, that crash in certain hormones (particularly progesterone, which drops after you give birth, sometimes causing dreadful PMS) leads to depression. It takes the body a while to “remember” and kind of grease the gears to return to its cycle.
The other problem that is common after childbirth is stress, which depletes hormones. Who is more stressed, more sleep-deprived, more exhausted than a new mom? We used to live in a village where family members, friends, and connections helped us raise a child. We don’t live in a village anymore, and we lack the resources to restore our body systems by having somebody else hold the baby while we take a shower.
I remember when I was in residency and had my daughter. I’d go to the clinic early and literally lie on the floor, because I couldn’t get up. I’d stay there until I had to start seeing patients. I had the physical drain of different hormones needed to produce milk, the drain of lack of sleep, and the drain of “being on call.”
When I first got my pager, I was so excited. Somebody was telling me that a patient was very sick, and there were all those issues to be dealt with. I turned to the nurse and said, “You’d better call a doctor.” She said, “You are the doctor.” At that moment, I realized the responsibility I had stepped into in this long white coat. Throughout my residency, I never got over the stress of being on call.
When you’re a new mom, you’re on call, too. It’s: “Is the baby going to cry while I shampoo my hair?” or “Will she be hungry?” And you never relax.
Maybe some new moms eat right, but I didn’t. I wanted to lose the baby weight and was tired and wasn’t cooking nutritious meals for myself. I didn’t have to cook for the baby, who was breast-feeding. All the pillars that are the foundation for an amazing house of health—sleep, nutrition, stress management, support, relationships, doing stuff for yourself—didn’t exist.
For me, it was even harder, because my husband worked out of town at the time. He was gone for three weeks and home for one week. So I was on call 24/7. He was utterly amazing when he was home, but I missed his support for our daughter and the connection we had as a family when he was away.
As you enter perimenopause, hormone production declines significantly in the ovaries, and the adrenal glands need to pick up the slack. When menstruation ceases and we enter menopause, the ovaries stop functioning and producing hormones altogether. Our bodies were designed to handle ovarian decline with the adrenal backup system to help maintain our quality of life. Today, however, the adrenals don’t work well enough to produce the hormones we need. Our twenty-first-century lifestyle has created conditions that make it impossible for our adrenal glands to thrive (known as adrenal insufficiency). We’re left with inadequate hormones to feel, look, and function at our best.
The Orchestra Players
As you will see, testosterone is the star of the hormone symphony. But, first, let me introduce you to the supporting cast, especially estrogen and progesterone.
Estrogen, which is also present in men (although at a much lower level), has a big job to do for women. For example, estrogen regulates female sexual characteristics. In puberty, this hormone is responsible for the growth of curvaceous hips and full breasts. Estrogen also builds the uterine lining during the first part of a woman’s menstrual cycle, in preparation for possible pregnancy. If pregnancy does not occur, this lining is sloughed off as a period.
Estrogen regulates the menstrual cycle, is in charge of the reproductive system, and supports a healthy sex life. The drop in estrogen during perimenopause and menopause plays havoc with your sexuality, causing loss of desire and vaginal dryness, which can lead to painful sex. Add night sweats and hot flashes, and it’s hard to feel sexy.
Optimal Estrogen Levels
Help build bone
Support your sex life
Help your brain
Help mood and sense of well-being
Affect the urinary tract, heart, and blood vessels
Support skin, hair, pelvic muscles, and breasts
Have been shown in studies to protect against Alzheimer’s disease
Adequate estrogen levels are also essential for thinking and memory. Memory loss is a normal fact of life as the brain ages, but the loss is magnified when estrogen declines. A University of Rochester study published in 2013, in the journal Menopause, sheds light on the effect of menopause on cognitive functioning. Researchers followed 117 women, ages forty to sixty, in various stages of menopause and found that those who were in their first year of postmenopause experienced far greater cognitive decline and memory loss than those in perimenopause. Hormone loss was seen as the probable cause.
Estrogen and Surgical Menopause
Surgical menopause, also known as a hysterectomy (removal of the uterus) and an oophorectomy (removal of the ovaries), causes an immediate jolt to women’s lives as levels of estrogen and other hormones plummet overnight. Studies show that hysterectomy shoves women into full-blown menopause earlier, even if they retain their ovaries. Depression and sexual problems, such as low libido and vaginal dryness leading to discomfort during sex, are common.
Cognition and memory often decline, too. The younger a woman is when she has surgical menopause, the faster cognition and memory issues develop, according to a study of eighteen hundred postmenopausal women. The findings were presented in March 2013 at the American Academy of Neurology.
The Estrogen Trio
There are three main types of estrogen: estradiol, estrone, and estriol. They exist in different ratios depending on the stage of life you’re in.
Estradiol is the predominant hormone of our youth. In the childbearing years, our ovaries produce mostly estradiol (80 percent) and the rest is equally divided between estriol and estrone. As we enter menopause, the ratio changes, and we produce predominantly estrone. Each of these estrogens is broken down, primarily through the liver, into other estrogens, and each has a role to play in our health and the diseases that affect us.
Estrone is broken down into three different components with varying functions: 2-hydroxyestrone, 4-hydroxyestrone, or 16-hydroxyestrone. The first, 2-hydroxyestrone, helps protect us from breast cancer. In contrast, 16-hydroxyestrone helps build bone, but it encourages multiplication of cells that can cause cancer. Higher than normal levels of 16-hydroxyestrone are found in women who have breast cancer. In addition, 4-hydroxyestrone has an association with cancer, too. Fortunately, you can actually guide estrone to be more protective. I’ll show you how in future chapters.
Estriol is produced in significant amounts only during pregnancy. The adrenal glands manufacture a little estriol, too. Estriol is a weaker estrogen compared with estradiol and estrone. Estriol, which is available over the counter, can alleviate hot flashes and vaginal dryness. I will discuss estriol’s treatment benefits more fully in Chapter 9.
Do You Have Low Estrogen Levels?
Major sex-hormone growth occurs during puberty and peaks at around age twenty-eight. Decline begins thereafter. Below is a list of common symptoms of estrogen deficiency.
Fill in the number at right that applies to you:
1. I have hot flashes.
2. I have night sweats.
3. I have vaginal dryness.
4. I have bladder leakage when I cough, sneeze, or run.
5. I get very emotional five to seven days before my period begins.
6. I am over forty years old.
7. I have difficulty sleeping.
8. I have lost interest in sex.
9. My perio...
"About this title" may belong to another edition of this title.