Coping with the ups and downs of hormones

Somewhere between the two age brackets of 12 to 15, and 50to 55, a woman’s reproductive system produces two very significant hormones, oestrogen and progesterone, that regulate the monthly menstrual cycle. Outside of pregnancy, the ebb and flow of these hormones are responsible for a number of physical and psychological symptoms that can sometimes become too difficult to deal with alone.

It is at these times that women often seek advice about lifestyle and nutrition, and treatment with pharmaceutical or herbal medicines.

“The most common problem for younger women is premenstrual syndrome [PMS] when they experience irritability, bloating and mood swings from ovulation onwards. They find they are narky in relationships and at work,” says Dr Rachel Mackey of the Women’s Health Clinic in Dún Laoghaire, Co Dublin.

The first advice Mackey gives women with PMS is to improve their diet by eating complex carbohydrates, avoiding sugary foods and taking Vitamin B Complex supplements that help balance these female hormones.

“Exercise is also hugely helpful; especially aerobic exercise, which releases endorphins,” she says. “Sometimes, it’s difficult to motivate women who are already suffering with these symptoms to make changes to their diet and lifestyle.

“The medical approach is the oral contraceptive pill or a low-dose antidepressant or anxiety drug called selective serotonin re-uptake inhibitors [SSRIs] taken from ovulation onwards. Although the SSRIs work well, most patients feel it’s more acceptable to be on the pill,” says Mackey.

Dr Dilis Clare, GP and medical herbalist, feels it is “a tragedy for women aged 16-21 to go on the contractive pill for hormone symptoms when they don’t need it for contraception”.

According to Clare, there are herbal tea blends and tinctures that get very good results for hormonal imbalance problems. “Herbs such as motherwort, verveine, liquorice and sage all help,” says Clare.

She believes a blend of valerian and crampbark works as well as pharmaceutical medicines for period pain.

Whether young women combine diet, exercise and medicines to treat hormonal imbalances is a personal choice, but what is noteworthy is that they will seek help.

“Young women are more confident and more likely to flag up a problem and talk about it than previous generations who sometimes thought there was something shameful about talking about period problems,” says Mackey.

Hormone trials

Mackey and Clare agree that the female hormones tend to settle down in the childbearing years.

“The 30s and early 40s are the most stable time for women who are in the throes of having children, and those who aren’t are usually on contraceptives. Pregnancy and breastfeeding are very stabilising in terms of the hormones. Hormonal imbalances can reappear again in the 40s; they are sometimes labelled as PMS but it is in fact the peri-menopause,” says Mackey.

“I see women who have been told they aren’t peri-menopausal because blood test results don’t show a decline in hormones, but they are miserable from ovulation onwards.”

The now famous 2002 Women’s Health Initiative hormone trials, which showed a link between hormone replacement therapy (HRT) and breast cancer in post-menopausal women, put a lot of women off the idea of taking hormones to relieve menopausal symptoms.

“HRT went from being the norm to being poison to be prescribed, but when the study results were teased out it was found that the average age of women was 63 and many of them had already been on HRT when they entered the trial,” says Mackey. “When they looked at the 45-55 age group, an increased risk for breast cancer wasn’t found.”

Mackey says she offers a low-dose contraceptive pill to women suffering from menopausal symptoms up to the age of 50.

“I prescribe HRT to women aged between 45 and 55 for up to five years if there is no family history of breast cancer. But the majority of women don’t need HRT once they have been given reassurance and understanding about their symptoms.”

According to Mackey, women suffer more from psychological symptoms when they still have their periods but the hot flushes and night sweats become more predominant once they have stopped menstruating.

“When the psychological symptoms are at their worst, most women need reassurance that they are not going mad. I always start by suggesting physical exercise and diet, things like yoga and meditation; anything that gives them time to focus on themselves.

“I find that women who are working full- time outside the home have a lower tolerance for symptoms and are more likely to seek medical intervention. Women working from home are sometimes better able to manage their symptoms more easily because they are not on show or in a male-dominated workplace.

“There will be about 10-15 per cent of women who have severe symptoms that are incompatible with normal living.”

Clare says that, generally speaking, “One-third of women won’t have any menopausal symptoms, another third will have minor symptoms and only one-third will have severe symptoms.

“Menopausal women need to do strong physical movement such as yoga, salsa, tango or set-dancing. I would prescribe herbal medicines, and HRT for three to six months for women who are exhausted by poor sleep, anxiety and other severe symptoms. Then, I’d wean them off the HRT while the herbs get to work. For women with mild to moderate symptoms, I’d prescribe only herbal medicines,” she says.

Plan coasting days

In closing, Clare suggests that menstruating women would be well advised to plan their lives around their monthly cycle. “A lot of women’s hormonal problems happen because women are outpacing themselves when their resources are low.

“The key is to do difficult things in the first half of the cycle and plan coasting days for the last four to five days. So, if you’ve a presentation to do at work, aim to have it in the first 10 days and don’t do your tax returns on the day before your period.”

This more creative approach to managing the menstrual cycle, from menarche to menopause, is explored further by the Women’s Quest founders, Alexandra Pope and Sjanie Hugo Wurlitzer. The details of this would require another article to explore. See womensquest.org

The reproductive system and the hormones that dictate it

What is menstruation? The monthly menstrual cycle begins when a woman ovulates or releases an egg that has been ripened within the ovary into the prepared uterus (the lining thickens to accommodate the egg). If the egg isn't fertilised, the thickened lining of the uterus (womb) and the unfertilised egg pass out through the vagina during menstruation.

Which hormones control ovulation and menstruation? The endocrine system consists of endocrine glands that release chemicals called hormones into the bloodstream to target specific organs.

In adult women, the two ovaries release eggs and produce the female sex hormones, oestrogen and progesterone. These hormones control the menstrual cycle from puberty to the menopause. The length of the cycle varies from 21 to 35 days.

What symptoms are associated with menstruation? The fluctuating levels of oestrogen and progesterone during a woman's lifetime are responsible for a wide array of symptoms of varying severity and duration.

Serious female hormonal imbalances can lead to periods stopping completely or becoming very heavy.

Other symptoms of hormonal imbalance can include sore or tender breasts, back pain, fatigue, anxiety or depression, sleep disturbances, craving for sweet foods, acne and decreased libido.