Hormone Panic
Life is full of unshared knowledge, secrets kept on dusty shelves, dismissed as not critical enough to share. Things no one thinks to tell you. Like to always have small change on hand when your kids are in the age of wiggly teeth. Or how tears unstoppably blur your vision when, before donating the kids’ old jackets, you check the pockets and find rocks, twist ties, bits of dried Playdoh, and other tiny treasures from their years of toddler awe and innocence. The fact that an aging woman’s body will slowly (or suddenly) stop producing the vital female-centric hormone, estrogen, that helps keep her internal systems properly functioning, her mind steady, and reduces her risk of comorbidities, is one of those boxed and shelved pieces of information despite it relating to the health of approximately one billion women worldwide.
Venus, women, Mars, men. We’ve heard the sayings. But when it comes to biology, certain facets of female and male bodies, primarily related to sex hormones, truly work differently and take distinctive journeys at puberty and into the sunset years of life.
I don’t remember much about health class in grade school. Well, I remember it came to light that my class had not been taught sex education at all. While the other grades obediently sat through the standard musty films and slideshows of anatomy and reproduction, my class had consistently missed being taught the health unit. And so it was, in the last two weeks in June, before school let out for the summer, me and my fellow days-away-from-graduating grade eight classmates, sat through a few years worth of sex ed. I hold loose visions of videos explaining male and female anatomy, narrated by an American-sounding man circa the 1960’s era of men in pin suits drinking scotch in dark smokey rooms. My memory conjures feelings of uncomfortable disconnect.
***
When my doctor called me with the results of my bloodwork, spotlighting perimenopause, since my estrogen levels were measuring very low “for my age,” I felt a queasy rush of mortality. I appreciated her forthright command of the call. I could tell my situation was serious. She recommended I go on HRT, rapidly relaying that it may take a bit of time to find the right dosage, and reiterated that I didn’t have to go on HRT, but if I wanted to, she had already faxed my pharmacy with the script. She spoke strongly and swiftly, or perhaps it was just my brain moving slowly, trying to absorb and understand what the heck she was talking about. I finally found a pause to interject and ask, “What is this thing you want me to take? HR-something?”
“HRT. Hormone Replacement Therapy. Essentially, you take low levels of the hormones you’re depleted in, to boost your current hormone levels — not all the way to where they were, but to a level that buffers sudden drops. You need estrogen and progesterone. It won’t stop menopause, but it should make the transition a little smoother. It’s safe, don’t worry.”
I hung up feeling overwhelmed and like a bit of a dummy. I placed my phone on the counter and anxiously tapped my fingertips against the cool marble trying to process the whirlwind of words from my doctor.
Perimenopause.
Early for my age.
Plummeting estrogen.
HRT…Hormone Replacement Therapy.
Safe?
Little realizations began to spring up. I recalled recently hearing some women talking about HRT. They were friends of a friend and I had come into the conversation late, and I didn’t understand what they were talking about. I nodded along, trying to look like I was in the know. It seemed they were talking about their mood… or was it their bodies? I was too shy and embarrassed to ask what HRT was or entailed. They were all raving about it though.
“It’s life-changing,” said one.
“I wouldn’t be able to leave the house without HRT. It’s totally saved me,” said another.
“Saved my marriage!,” piped in a third, and the rest laughed. Then the conversation turned to children’s screen addictions, and although part of me wondered about those 3 little initials the ladies were gushing about, I filed them away in the not-sure-if-this-is-relevant-for-me cabinet in my brain, and life carried on. Until my doctor called me, that is.
As flashes of these HRT conversations cycled through my brain, a thought arrived like a deafening thunderclap. Do I even know what hormones are and do?? Specifically. Surely I must. I’m a trained Health Coach! But… specifically. I mean, we all know that boys have testosterone - that’s what makes them aggressive and manly! And girls are full of estrogen - that’s why we cry and get dramatic. Right?!
My brain doesn’t feel still very often, but right then it was stunned in suspended silence. I shook myself out of my stupor and turned to my laptop. First I Googled: What are hormones? The Cleveland Clinic put it succinctly:
Hormones are chemical messengers that coordinate different functions in your body.
Next, I spent hours spiraling through the internet’s vast offering of information. I rushed to the used bookstore by my house and came home with an armful of outdated-looking books on women’s health, hormones, and menopause. Tacky covers of smiling women in bodysuits, with big hair and bright pink lipstick piled on my desk and floor. Back online, I ordered four more books published in this decade.
And I read.
I read and re-read while I fed my kids, waited for appointments, and well into the quiet hours of the night. I bought the audio version of the books that I found most informative so I could continuously cram the info into my head as I drove, grocery shopped, or folded laundry. I needed to learn everything about hormones and menopause and how they affect the body. It turns out there is a lot of information out there, it’s just open, unstigmatized dialogue that’s lacking.
I scribbled colour-coded notes as I learned that hormones instruct bones, muscles, and tissues to grow. They control appetite, body temperature, and fat storage, and affect the brain (including mood and emotion regulation), the heart, the skin, and more! I read about how when hormone imbalances occur, hormone messages weaken or even disappear. This can make the body feel and act out of whack. Catching a red light on the way to work might trigger a torrent of tears. Thoughts of being unloved or not important crowd the consciousness. Nights of tossing and turning, or obsessing over baffling weight gain, can easily become the norm. The sensation of being starving might roar up at nine o’clock at night despite having eaten just a couple of hours earlier. Our body responds to the messages it receives from hormones so if these messages deviate from their regular programming, our body follows suit.
In a woman’s body, a form of estrogen (there are three), called estradiol or E2, is the communication commander for a good chunk of our lives, the reproduction years — puberty until menopause. Estriol (E3) is produced during pregnancy and is otherwise barely detectable, and estrone (E1), a much less potent form of E2 is the primary form of estrogen produced in a woman’s body after menopause. Progesterone and testosterone play important roles too (we’ll get to those in another chapter), but E2 is the lead, the queen, the prima donna calling the shots. Through the perimenopause years, estradiol decreases until it finally flatlines. The danger is that without E2, women face an increased risk of illness such as depression and heart disease, among other serious conditions. E2 affects the brain and the body, so its departure can send women into a tailspin of mental and physical anguish.
I asked my friends if they knew about hormones and their functions, and was met by frowns and silence or self-proclaimed ashamed generalizations like the ones I had first produced. When I blurted out bits and bobs from my research, besides horror and an instant shot of anxiety rippling across their faces, the same two questions escaped from each person’s lips.
How come we don’t know this? And why aren’t we talking about this stuff??
***
Hormone Replacement Therapy (HRT), increasingly referred to as Menopausal Hormone Therapy (MHT), is the administration of synthetic hormones that mimic some of the functions of natural hormones. It isn’t right or necessary for every woman to go on hormones — menopause and symptom management is a deeply personal journey. For those interested though, HRT treatment can help alleviate: hot flashes, night sweats, anxiety, depression, anger, brain fog, moodiness and mood swings, and vaginal dryness.
Unfortunately, HRT has a bad reputation it’s been trying to shed for two decades. In the early 2000s, alarming health information was published by the Million Women Study out of the UK, and from the Women’s Health Initiative (WHI) out of the USA. They reported that extended use of HRT can increase the risk of cancer and cardiac conditions, namely uterine and breast cancer, heart disease, and stroke. Unsurprisingly, this news contributed to waves of fear and women abandoning, or refusing to consider the use of hormones to ease symptoms of menopause. Suffering through them seemed the better option.
The problem with the reported information though, is that it wasn’t fully explained or examined until a little later. Most of the women in the WHI study were already postmenopausal having an average age of 63, the eldest being 79 years old. Many participants carried other health risks and were generally sedentary women who were not in a healthy weight range. The purpose of the study was to see if hormone therapy would help reduce a woman’s risk of conditions such as osteoporosis and heart disease during their postmenopausal years. It did not. It was too late.
The participants of the Million Women Study were younger and generally more active with healthier body compositions, but reports stated an increased risk of breast cancer. However, the doses the women were given were higher than is typically prescribed today. We have better knowledge, dosing calculations, and varied application methods today. For one thing, every woman needs a custom dosage depending on her hormone levels and symptoms, and very importantly, if a woman has a uterus, she must take progesterone when taking estrogen as estrogen alone can thicken the uterus lining and cause cancer. No uterus, no need for progesterone (unless a doctor recommends it for other reasons).
Further reviews of the two studies though, showed that HRT can be a safe, effective, and proactive health tool when dosed lower and used within a ten-year window of a woman’s menopausal symptoms and before the age of 60. A 2014 review concluded that hormone therapy not only helps elevate menopause symptoms such as hot flashes and mood swings, but also helps prevent bone loss and fracture, reduces the risk for heart disease and cancer, and improves a woman’s metabolic health, so long as it’s used within ten years of her last period. It can be very effective for managing depression. Sadly, Canadian statistics show that in women, the highest rates of suicide fall between the ages of 45 and 64. It’s not a coincidence the data coincides with the menopausal years.
The updated findings weren’t as widely publicized and vocalized as the initial vague, erroneous, terror-inducing messaging. It’s hard to recover from a scandal, so the stigma and fear of HRT/MHT remains today. The residual fear, I realized was already embedded in me. Although I wasn’t consciously aware of the hormone stigma at the time, I must have unknowingly picked up on it in my younger years because the moment my doctor mentioned HRT, a deep-seated fear rocketed forth, ringing cancer alarm bells. But reassurances from my doctor and reading about the newer published findings of the earlier hormone studies made me feel… skeptically okay about taking hormones. I decided to continue with my research though, and see if my symptoms were improving on their own. Because you know, if you ignore problems, they go away…
***
After weeks of swimming through all the material on hormones, HRT/MHT, and menopause, I reviewed and digitized my notes into a cheat sheet deck of information. My section on the role of estrogen (specifically estradiol) is as follows:
E2 influences muscle structure and strength. When it diminishes, the body loses lean muscle mass.
E2 builds bone density and helps with calcium absorption.
• E2 supports mitochondria functioning by helping the body clear away free radicals which can damage healthy cells (free radicals appear during cardio-type of exercising)
Estrogen can be anti-inflammatory or promote inflammation! As E1 becomes the main form of estrogen and E2 dwindles, their imbalance can cause systemic inflammation. Systemic inflammation can lead to sore joints, gut issues (as the healthy gut microbiome is damaged), and puffiness from fluid retention.
E2 regulates insulin and glucose activity. Low levels of E2 contribute to becoming more insulin-resistant meaning the body can’t effectively use blood sugars. And so… the blood sugars become fat gain.
E2 regulates the hunger and satiety hormones, helping curb hunger cues. When it flatlines, ghrelin, the hunger hormone is left unchecked leading to more cravings and less satiation.
E2 plays an important role in managing moods. It increases serotonin production, density, and activity, and prevents it from breaking down. When E2 declines so does serotonin which can lead to irritability, erratic moods, anger, impatience, irritability, and restlessness. This can lead to feelings of depression. E2 also helps control cortisol the stress hormone. When cortisol levels are high, feelings of anxiety and stress are too. In this state, digestion slows, one more thing adding to potential weight gain.
E2 helps manage body temperature. When levels fluctuate and decline the brain may think the body is too hot when it’s not. It activates the widening of blood vessels and sends fluid (sweat) onto the skin to cool you down. Hello, hot flashes!
E2 helps regulate blood pressure. Without it, blood pressure rises which increases the risks of heart disease and can make heart rates higher than previous rates, both when resting and during exercise.
Vagina comfort - estrogen stimulates tissue growth to maintain the thickness of the vaginal lining, as well as moisture. When it declines the vaginal walls thin and become drier which can make activities like sex and cycling painful.
What the mother eff. How is any woman past menopause still alive?!
I sat for a moment feeling completely ill. Utterly doomed. I ran to my bathroom, where the unopened estrogen patches and progesterone pills sat, and pulled them out of their packaging. I forgot all my calming, measured life coaching skills, as I applied an estrogen patch to my rear end and popped a progesterone pill. And like opening a sack of flour in a windstorm, my brain exploded into a flurry of panic.