Katie Lane Talks about Promoting a healthy cycle, and identifying hormonal imbalance

 

Katie is a Nutritionist and writer for Cleanmarine, working on both the PeriodPlan and MenoMin brands. Since graduating in 2012, she has worked within the alternative health industry in both Australia and the UK. In this article, we take a deep dive into all things hormone-related.

 

What are hormones?

Hormones are chemical messengers, agents of the endocrine system, and responsible for a myriad of chemical processes throughout the body. This page focuses on sex hormones (also called gonadal steroids or gonadocorticoids), the primary function of which is involved in sexual development and reproduction. Sex hormones are produced primarily within glands called gonads -the ovaries and testicles. The adrenal glands and other tissues (e.g. fat tissue) can also produce sex hormones.

Sex hormones include Oestrogen, Progesterone, and Androgens (the primary androgen being Testosterone), and while some of these hormones could be considered specific to one gender, the truth is everyone produces these three hormone types. The information below is specific, however, to those with female reproductive organs.

What influence do hormones have on our body?

Hormones don’t just interact with reproductive organs and tissues. They influence many structures around the body, including the brain, heart, and muscles. According to what is currently known about hormonal health, hormone levels that align with what is considered optimal for life stage, are the foundation of a healthy reproductive cycle, and help avoid hormone-related symptoms.

What is hormone imbalance?

’Hormonal imbalance’ refers to any disruptions in the interconnected workings of hormones as part of the larger endocrine system. As mentioned, hormones are chemical messengers, and travel to and interact with all forms of tissue. They regulate more than just sexual functions. In the context of sexual hormones, ‘imbalance’ means fluctuations, over-presentation, or insufficiency of steroid hormones, which can be caused by any of the following: lifestyle changes (e.g. more exercise, less sleep, etc.), dietary changes or deficiencies, stress (emotional and physical), medical conditions (including sexual disorders), and regular ageing.

Effects of hormone imbalances

What do they look like and how does it affect the rest of the body?

It can be hard to tell if symptoms are caused directly by hormonal imbalances. Sex hormone imbalance can present in a vast number of ways, and there can be a lot of cross-over in symptom presentation to other health issues. Sex hormones influence how many bodily systems operate, so it can be surprising just how many ‘everyday’ symptoms could be  related to hormone levels. The NHS lists a number of symptoms that could be associated with hormone imbalance. Some are directly related to reproductive organs, such as changes to menstrual cycle regularity and condition (e.g. changes in consistency, length, amount of blood lost), health and presentation of secondary sex organs (e.g. changes to breast tissue), and fertility issues. Some are more broad, like headaches, weight changes, digestive changes (e.g. bloating), water retention (oedema), sleep issues, skin issues, and mood changeability.

If sex hormone imbalance is a concern, healthcare professionals can test for hormone levels through the blood to ascertain whether or not they fit within healthy ranges.

Can other health conditions be involved?

Yes. Sex hormone imbalances may contribute to the development of other conditions, as well as be influenced by pre-existing ones. There are also several hormonal and reproductive disorders, which could be present, and diagnosable by healthcare professionals.

What to do if you experience symptoms of hormone imbalance?

When experiencing symptoms associated with hormonal imbalance it is important to discuss these with a health professional. Several actions might be suggested, for example, lifestyle changes, medical interventions, or changes to diet. This could include introducing a hormonal contraceptive device, many of which contain levels of different hormones which can help influence hormonal balance for an individual. Supplementation of certain nutrients may also be recommended, to potentially support the body in balancing hormones from a broader angle. A common middle ground between the two, are supplements that focus on supporting hormone balancing directly.

What can I expect to learn from this online resource?

This page, and the links within, had been made to be an ever-growing resource for helping to understand hormones, and how to promote hormone balance. Scroll down to read about menstrual health (what it looks like and how to promote it), common relationships between hormones and health, as well as useful links to resources on common hormone conditions.

Hormones and life stages puberty, menstruation, perimenopause and menopause

Pre-puberty

Sex hormone levels remain low until puberty. Puberty is the collective term for the time in which the body begins to produce hormones which stimulate reproductive organs, and lead to development of secondary sex characteristics. Ovary stimulation to mature eggs is controlled by the production and secretion of hormones from the pituitary gland in the brain. The function of this chain of hormones is to establish the menstrual cycle, and the timing of puberty is influenced by many factors, including brain development, genetics, and potentially diet.

Menstruation

First and foremost - what is the Menstrual Cycle? The Menstrual cycle is the name for a series of chemical and physiological processes that change the body, in cycles (typically month-long), to allow for pregnancy. It involves several hormones, which influence a variety of functions throughout the entire body, not just within the reproductive organs. The purpose of the cycle is to produce viable eggs, which, if fertilised, can imbed into the uterus lining. This lining has been built up within the first portion of the cycle, ready to receive the egg and support pregnancy. If no fertilisation occurs, the uterus lining sheds, as a period, and the cycle begins again. Whether or not a pregnancy ever occurs, this cycle continues, month on month, and won’t stop until Menopause -the name for when ‘egg reserve’ is depleted and oestrogen naturally declines.

 

This cycle can be altered or deliberately interrupted through medical interventions such as the oral contraceptive pill. For more information about contraceptive options, please visit: https://www.nhs.uk/conditions/contraception/

 

In an ideal world, according to modern medicine, this cycle would fit within a neat range of parameters and operate without significant change. Hormones would work to a specific pattern of rising and falling, harmoniously operating alongside each other, and the cycle is relatively symptomless. However, this simply isn’t how many experience their cycles.

 

All manner of internal and external factors can influence this cycle. Genetics, disease, stress, and environmental factors, can all impact in a variety of ways, some easier to spot than others. Periods can be unreliable, absent, late, short, light, heavy, painful -all manner of presentations. Symptoms associated with the menstrual cycle and/or hormone levels can appear at any point in the month. This might surprise some, as it is commonly the symptoms that typically appear alongside periods (e.g. cramps), or just before periods, that get the most attention. A common syndrome (set of symptoms) called PMS (Premenstrual Syndrome) is the term given to symptoms that appear in the few days leading up to periods and can be experienced acutely or in a familiar rotation.

 

For a much deeper look into the menstrual cycle, follow this link: https://inspiredhealth.co.uk/blogs/wellness/your-cycle-101

Perimenopause

Perimenopause is the transition period between regular cycles, following the typical pattern outlined above, and true menopause. It is itself characterised by a decline in hormonal levels associated with changes in ovarian function. This period of time can involve fluctuations of sex hormones which can lead to new symptoms appearing. The onset of perimenopause is common between the late 30’s and mid 40’s, and lasts for several years.

 

Common Symptoms of Perimenopause:

• Irregular Menstrual Cycles: One of the earliest signs of entering perimenopause. Cycles might become shorter, or longer, with or without flow changes. This may also include missed periods.
• Night Sweats or ‘Hot Flushes’: A ‘hot flush’ or ‘hot flash’ is an acute, intense feeling of warmth over the body, which can be accompanied by sweating. This can happen at night, interrupting sleep, or during the day, and may involve changes to heartbeat as well. Heart rate can increase by as much as 8-16 beats per minute during an episode.
• Changes to reproductive tissues:

-Vaginal dryness and thinning of the muscular lining of the vagina can occur as oestrogen levels decline. This can be uncomfortable as well as increase risk of infection like Urinary Tract Infections (UTIs).

Breasts can become more tender.

• Mood and cognitive changes: As discussed earlier, hormonal changes can influence mood. Libido might also decrease. Changes to working memory, concentration, and general cognitive function might be observed.
• Sleep Disturbances: Changes in hormone levels can disrupt sleep patterns, leading to insomnia or more shallow sleep.
• Weight changes: Hormonal changes and a slowing metabolism can contribute to changes in body composition.
• Bone Health: Oestrogen plays a role in maintaining bone density. Declining oestrogen levels during perimenopause can contribute to a gradual loss of bone density, increasing the risk of osteoporosis.

Menopause

Menopause marks the end of the reproductive years. This is also considered a part of the general ‘transition’ stage, and considered ‘true menopause’ when there have been no periods for 12 (consecutive) months. Menopause is marked by significant oestrogen decline and symptoms associated with oestrogen being much lower than in previous years, driven by the depletion of the ‘ovarian reserve’ of eggs.

 

Symptoms of menopause can include:

• The cessation of menstruation.
• Symptoms similar to perimenopause

o             Night sweats

o             Hot flushes

o             Changes in sleep

o             Weight changes, typically weight gain

o             Changes to reproductive tissues vagina and breast tissue

o             Mood and cognitive changes

• Incontinence
• Bone health decline e.g. An increased risk of fractures and conditions like Osteoporosis
• Changes to the cardiovascular system

 

The individual symptoms of perimenopause and menopause can vary significantly from person to person. Symptoms can range from ‘minimal’ or ‘severe’ impacting daily life appreciably. As the severity and duration of symptoms can vary so much, it can be hard to tell when the stages begin and end. Luckily hormonesupporting nutrients can be used at any point during these transitions to promote general hormonal support. Medical interventions may also be considered, such as Hormone replacement therapy (HRT) or other treatments, to help manage symptoms, all of which would be discussed with a healthcare practitioner.

 

Post Menopause

What you can do to protect yourself from symptoms ongoing

On top of what is already known about healthy hormonal patterns, there is also still a good deal of research needed into women’s health to fully understand the relationship between hormone levels and life experiences. For example how to recognise and treat hormonal disorders. Many charities across the UK are working to increase information on hormonal disorders.

 

These include:

http://www.verity-pcos.org.uk/ -Verity PCOS charity

https://thebms.org.uk/ -The British Menopause Society

https://www.endometriosis-uk.org/ -Endometriosis UK

 

There are many good resources for people wanting to know more about hormone disorders, and menstrual cycles, including what to expect, lifestyle factors that influence symptoms, and other women’s stories. These include podcasts, books, and official resources.

 

The NHS provide a number of links to follow under the branch of ‘Women’s Health’, specific to menstrual health, hormone syndromes, and reproductive organs - https://www.nhs.uk/womens-health/

 

Hormones and Energy

Imbalances in sex hormones can impact energy levels, for example, low oestrogen levels can be associated with fatigue. Oestrogen plays an important role in the regulation of energy in the body. It is necessary for optimal mitochondrial function the organelle inside cells that make energy. Oestrogen can aid the mitochondria in making more energy molecules.

Oestrogen also plays a role in the production of neurotransmitters serotonin and dopamine. These neurotransmitters are a part of mental motivation pathways, which can increase mental and physical energy. Lower levels of these neurotransmitters are associated with depression and fatigue. Oestrogen also helps modulate insulin function, the hormone that regulates blood sugar levels. Balanced blood sugar levels are a big part of feeling ongoing levels of energy throughout the day. Some say that when Oestrogen is highest, towards the middle of the cycle, they have more expendable energy. This can even extend to feelings of increased stamina and endurance. Drop in Oestrogen towards the end of the month, where progesterone takes over, can leave some feeling more fatigued.

Hormones and sleep and rest

Inadequate sleep, rest, and downtime can impact hormones, and vice versa. Times in the month individuals might feel the need for more rest can be around menstruation, when the system is effectively going through a purge and reset stage. Lower levels of oestrogen at the end of the cycle can also influence higher levels of fatigue.

Higher levels of oestrogen have been associated with higher sleep quality, so during the follicular phase, some report better sleep. In the luteal phase, especially around ovulation when body temperature can shift slightly, there is potential for sleep to be disturbed. Higher levels of progesterone in the later part of the cycle can influence feelings of calm and relaxation, aiding with sleep.

Hormones and digestion

Oestrogen and digestion have a complicated relationship. Oestrogen can influence the movement of food throughout the digestive system, as well as potentially influence the presence of symptoms like bloating and constipation. Higher levels of the hormone in pregnancy can influence the latter.  During menstruation, prostaglandins are released to encourage the uterine lining to cramp to promote the release of tissue. This can also influence the bowels and cause increased bowel movements, generally on the looser side.

Hormones and appearance

Oestrogen fluctuations can influence skin appearance. Hormonal acne can be a sign of hormonal imbalances, and might include increased levels of sebum production, creating an oily complexion. Oestrogen promotes collagen production and skin thickness, which is why during menopause, skin can start to appear thin and dry. Oestrogen also promotes healthy blood flow to the skin, influencing skin health but also that of the hair and nails. During pregnancy when hormones are higher, there can be greater hair growth and volume. Sex hormone fluctuations can allow for skin quality to change throughout the month, with some reporting better skin appearance around ovulation, when oestrogen is higher. 

Hormones and immunity

General immunity can be affected by sex hormone levels. Lower levels of hormones just before and during menstruation sometimes allow for feelings of having a ‘mini flu’.

Optimal hormone balance works alongside the immune system to maintain high levels of immunity. Oestrogen receptors are found on immune cells, indicating that the presence of this hormone can promote immunity, even if the exact mechanism is not understood.

Hormones and brain function/cognition

Lower oestrogen levels can promote feelings of reduced brain function by affecting the prefrontal cortex, which controls memory, organisation, personality, mood etc. When oestrogen is low, before a period or during perimenopause and menopause, people report symptoms of lack of cognitive ability and clarity, with higher reports of brain fog for instance. Oestrogen also has neuroprotective properties and supports general brain function.

 

Hormones and Thyroid function

Sex Hormones are part of the endocrine system which also includes the hormones of the thyroid and adrenals. The Thyroid is an organ that sits, in a butterflylike shape, at the front of the throat beneath a piece of cartilage that is colloquially known as the ‘Adam's apple’. The size of this cartilage alters person to person, and more obvious in some. This gland is most wellknown for the roles it plays in metabolism. It is part of a chain of hormonal glands, the first two of which are found in the brain, called the HPT-axis (Hypothalamus, Pituitary, Thyroid axis). The hormones involved in the regulation of the thyroid, impact sex hormones, and if this system is dysregulated, sex hormones can be negatively affected. This could be part of thyroid disorders, but also due to other factors, like high levels of stress.

Sex hormones can be imbalanced if the thyroid isn’t functioning optimally. Thyroid testing involves a blood test to ascertain the levels of two chemicals Thyroid Stimulating Hormone and T4 the chemical the thyroid makes. Rather crudely, these two levels can give you an idea of what messages the thyroid is getting, and then what it can do with that. Imbalances in thyroid function (over and underactivity) can impact the development of ovarian and endometrial (uterine) tissues.

 

PMS

Premenstrual syndrome (PMS) is a collection of symptoms that can appear in the later portion of the luteal stage, typically a few days before bleeding begins. There are around 150 recognised symptoms that are considered part of PMS, both physiological and psychological. Typical symptoms can include:

• Psychological

Changes to sleep, mood, and brain function, including increased feelings of depression and anxiety, and general emotions; insomnia and changes to sleep patterns; cognitive changes like brain fog, poorer focus and concentration

• Physiological

Digestive changes, like bloating, cravings, constipation; Sensitivity in reproductive tissues, e.g. breast tenderness, and increased sensitivity to pain in general; changes to skin, possible acne breakouts; Muscle aches and pains; increased tiredness and fatigue; and water retention, e.g. oedema in extremities (hand, feet, ankles).

 

PMS apparently affects between 30-40%, with anywhere between 3 and 10% of these describing their symptoms as severe enough to ‘impact on their lives’. There is yet no clear understanding of the mechanisms behind PMS, except to say that it is recognised to involve more than just sex hormones. Research suggests that PMS, and other menstrual syndromes, are caused by interactions between sex hormones and neurotransmitters (e.g. serotonin), and influenced by genetics and social context. As sex hormones interact with many areas of the body, these hormones, e.g. Oestrogen, can influence neurotransmitters in the brain, and PMS could be the emotional and physical manifestations of this.

When PMS symptoms involve changes to mental health, like anxiety and depression, or extreme mood swings, PMS might be reclassified as premenstrual dysphoric disorder (PMDD).

 

PMDD

PMDD is Premenstrual Dysphoric Disorder. A severe form of Premenstrual Syndrome (PMS), that can involve symptoms that dramatically alter one's ability to live life comfortably. It includes both physical and emotional characteristics, like with PMS, but to a degree that will impair daily functioning.

Affecting a small portion of those with PMS, PMDD symptoms include those which are part of the PMS criteria, but present more severely. These can include mood changes, increased experience of anxiety and depression, irritability, anger, and sadness. ‘Dysphoria’ is classified itself as a state in which someone feels an extreme sense of unease, and is a part of many definitions of mental illnesses.

Like with PMS, the likely cause is thought to be hormonal imbalances, and the effect that this can have on brain chemicals, such as neurotransmitters., like serotonin and dopamine.

 

Endometriosis

Endometriosis is a chronic, oestrogen dependent condition characterised by the growth of endometrial tissue outside the uterus. This leads to inflammation, and increased pain, and can involve the formation of adhesions and lesions.

The exact cause is still unclear, but likely a combination of genetic and hormonal factors involved. Mechanisms also thought to be involved include autoimmune conditions. Endometriosis is only confirmed as a diagnosis with laparoscopic surgery, to see inside the reproductive organs and areas around them. A diagnostic process that can last years.

 

 Symptoms of Endometriosis can include:

• Pelvic pain, with various degrees of severity, including dyspareunia (genital pain)
• Lacking periods
• Infertility
• Gastrointestinal and urinary symptoms

 

PCOS

Polycystic ovary syndrome (PCOS) is a common condition where several symptoms are associated with an elevated presence of the hormone luteinising hormone (LH). Follicle Stimulating Hormone (FSH) can also be out of healthy range, and combined, drive up androgen levels, which includes testosterone. It, too, can result in reduced fertility. Contributing factors are thought to be genetic, and environmental, involving disorder of other bodily functions, such as increased insulin resistance.

This is one of the most common reproductive disorders, diagnosed through blood work and internal examination of reproductive tissues and organs. Symptoms can include:

• Irregular cycles
• Irregular ovulation
• Increased body hair
• Acne, and/or increased sebum production
• Metabolic changes, increasing likelihood of weight gain
• Ovarian cysts are found in some cases