Transcript Women`s Health: Hormone Balance and Stress

Women’s Health:
Hormone Balance and
Stress
Henri J Roca, MD
Assistant Professor, Department
of Family Medicine, University of
Arkansas School of Medicine
Estrogen and Progesterone
 During reproductive years, ovaries
make high amounts
 Estrogen peaks at the beginning of cycle
 Progesterone peaks after ovulation
 Small amount of both made in Adrenal
glands
 Some estrogen also made in fat cells
Symptoms Associated with Menopause
 Hot flashes, flushes, night sweats and/or cold
flashes, clammy feeling
 Bouts of rapid heart beat
 Irritability, Mood swings, sudden tears
 Trouble sleeping through the night (with or
without night sweats)
 Shorter, lighter periods; heavier periods,
flooding; phantom periods, shorter cycles, longer
cycles
 Loss of libido
 Crashing fatigue
 Anxiety, feeling ill at ease
 Feelings of dread, apprehension, doom
Reproductive Hormones and
Dental Health
J Midlife Health. 2014 Jul-Sep; 5(3): 115–120; Ann Med Health Sci Res. 2013 JulSep; 3(3): 320–323.
 Estrogen receptors in oral mucosa similar to
vaginal mucosa
 Natural menopause is defined as a
spontaneous cessation of natural
menstruation for 12 consecutive months at
45-55 years of age
 paucity of saliva, increased dental caries,
dysesthesia, taste alterations, atrophic
gingivitis, periodontitis and osteoporotic jaws
unsuitable for conventional prosthetics or
dental implants. calcified carotid atheromas.
ORAL MANIFESTATIONS
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Effect on periodontium
Periodontitis
Oral candidiasis
Localized osteitis
Burning mouth
Trigeminal nerve involvement
Xerostomia and increase caries activity
Delayed healing
Progesterone and Pregnancy
 Increased in puberty, with OCP, during
pregnancy
 Changes in blood flow – red gums, more
reactivity to plaque
 Acid erosion
 morning sickness or esophageal reflux.
 Periodontal disease occurs in 50% to
100% of all pregnant women
Peri-Menopause
 Time from when symptoms start, lasting to 1
year after last menstrual period
 Symptoms:
 Increased PMS
 Irregular periods, or changes in length and flow
 Hot flashes, night sweats
 LH and FSH will be elevated: trying to get
the ovaries to make estrogen
 Ovaries respond with periodic bursts: Hot
Flashes
Hot Flashes
 80% of American women will have at least 1
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hot flash
Surge of power, heat, or energy being
released
Some completely debilitated
Thought to result from fluctuations in
estrogen levels
During peri-menopause, but can continue
into menopause
Exacerbated by low progesterone levels
Peri-Menopause
 Progesterone levels decline due to lack
of ovulation
 Increases in frequency through the 40’s
 Too much estrogen relative to
progesterone
 Estrogen Dominance
Estrogen Dominance
 Common symptoms
 Fibrocystic breasts
 Fibroid tumors of the uterus
 PMS symptoms
 Breast tenderness and water retention
 Mood changes
 Menstrual symptoms
 Menopause symptoms - especially hot
flashes
Menopause
 Decreased estrogen and progesterone levels
 Begins 1 year after last period
 Low Thyroid and/or low adrenals will make
symptoms worse
Burning Mouth Syndrome
 43% peri and menopausal; 6%
premenopausal
Xerostomia
 Estrogen receptors in salivary glands
 Flow rate including stimulated flow
rates are lower in postmenopausal
women
 Salivary pH and electrolytes are
unaffected
 Mandibular dysfunction, diffuse gingival
atrophy or oral ulcerations, oral
candidiasis, pernicious anemia
Periodontal Health
 Estrogen receptors in periodontal
osteoblasts and fibroblasts
 Decreased vascular flow in menopause
 Worse and more frequent periodontal
disease
Alveolar Bone Loss
 Strong association with osteoporosis
Counseling
Exercise
Phytonutrients
Detoxification and
Biotransformation
Inflammatory
Process
Excessive
exercise
Infectious microSpiritual
Dysbiosis
organisms
angst
Nutrient
Situational
insufficiency
stress – fear,
anxiety, worry The holistic/ functional
Xenobiotics
Structural
Integrity
Minerals
Nutrient excess
Vitamins
Psychological
medicine model
Adiposity
and Spiritual
recognizes and prioritizes
Equilibrium
Disrupted light
Drug side effects the patient’s full, unique
cycles – circadian
story and
Hypoglycemia
dysrhythmias
uses fundamental clinical
Toxic metals
Hyperglycemia
imbalances as a key
to treating complex,
Excessive noise
Radiation
chronic illness.
Genetic preDigestion,
Emotional
disposition
trauma
Food
toxicants
Absorption,
Oxidative
(SNPs)
(allergens, stimulants Aging
and Barrier
Reductive
etc,)
Integrity
Homeodynamics
Immune
Surveillance
Biofeedback
Meditation
Structural or
physical damage
Homeopathy
Hormone and
Neurotransmitter Regulation
Acupuncture
Manipulative
Therapies
Yoga
Diet
ENTER THE MATRIX
BRUXISM
Adrenal Glands
 2 glands, located on top of each kidney
 Cortisol: main stress hormone
 Sex hormones also made here
 DHEA, Testosterone, Progesterone, Estrogen
 As we age, Ovaries make less E and P
 Adrenals pick up the slack
 Healthier the adrenals, easier the transition to
menopause
Acute Stress
 High Cortisol
 Initially DHEA can be elevated
 Eventually, DHEA, T and E decrease because
all raw material is being diverted to make
Cortisol
 High Cortisol is good in acute situations:
 Increased blood sugar for fuel
 Shunt blood to periphery to run
 Decrease inflammation to manage response to
injury
Chronic High Cortisol
 Raises blood sugar - insulin/diabetes
 Abdominal obesity - risk for metabolic
syndrome
 Fluid retention and hypertension
 Breakdown of structural proteins - muscle
(sarcopenia), bone and connective tissue,
hair and nails
 Impairs immune system
 Chronic infectious diseases
 Lowers sex hormones
Chronic Stress:
Adrenal Fatigue
 Eventually, low Cortisol
 Saliva testing
 Low DHEA, Testosterone
 Less Estrogen and Progesterone
 Worsens symptoms of peri and menopause
 Symptoms:
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Fatigue
Hair loss
Joint pain and inflammation
Allergies
Auto-immune disorders
Thyroid Gland
 Low functioning - hypothyroidism
 High TSH, low T4, T3
 Nutritional causes- iodine, zinc, selenium, iron
 Auto-immune - Hashimotos Thryoiditis
 Symptoms
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Low body temperature, cold hands
Sluggish metabolism, weight gain
Fatigue
Constipation
Depression
Low libido
Menstrual disorders, severe menopausal symptoms
Hair loss, dry skin
Thyroid Hormones
 Thyroid gland makes T4 (4 iodine molecules)
 T4 delivers an iodine to all cells in your body
and is activated to T3
 T3 much more potent
 Many people have subclinical
hypothyroidism from low T3, or problems
with activation of T3, or removal of wrong
iodine
 Dependent on progesterone and cortisol,
among other nutrients (more later…)
Stress Issues and
Achieving All-Hormone
Balance
Stress and Thyroid
Function
 Stress suppresses hypothalamus’ release of
TRH, the pituitary’s release of TSH, and
thyroid gland production of thyroid hormone
 Decreased TSH, T4, T3
 Chronic stress: don’t convert T4 to T3
 Inflammatory cytokines - block conversion
 Adrenal exhaustion - low cortisol
 Cortisol needed for T4 to T3 conversion
 Healthy Adrenals Key to Healthy Thyroid
Stress and
Estrogen/Progesterone
 High Cortisol causes worsening of
Estrogen Dominance, low Progesterone
QuickTime™ and a
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Progesterone and Thyroid
 Progesterone helps convert T4 to the
activated form of T3
 Stress, adrenal fatigue and Perimenopause/menopause all cause low
progesterone
 Negatively effect the thyroid
 Can’t balance thyroid without balancing the other
hormones
Treatment approaches:
Perimenopause
 Chastetreeberry (Vitex): balances
estrogen and progesterone
 Compounded progesterone cream
 Hot flashes
 Not Effective:
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Wild yam cream
Dong Quai root
Evening Primrose
Vitamin E
Ginseng
Treatment Approaches:
Menopause
 Mind-Body Medicine: Studies show
reduction of hot flashes with:
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Relaxation
Self-suggestions of cool thoughts
Temperature feedback
Training in slow deep breathing
 Black cohosh (Remifemin 20 mg twice)
 Isoflavones from soy, kudzu
 Soy: Exact mechanism not known. Possibly
by weak estrogenic activity: blocks harsher
estrogens
Treatment Approaches:
Menopause
 Bio-identical Hormone Replacement
Therapy: Bio-HRT
 Vaginal Dryness:
 Estradiol only Estrogen cream: Estrace: 2
grams per night X 2 weeks, then 1 gram, 1-2 X
week.
 Sexual activity will increase mucus
 Avoid excess douching
Treatment Approaches:
Thyroid
 Iodine, Zinc, Selenium, Vit A
 Kombu
 Brazil nuts
 Thyroid hormone replacement
 Synthetic T4, T3 (Synthroid, Levoxyl,
Thyrolar, Cytomel)
 Natural T4, T3 (Armour, Naturthroid)
Treatment:
Adrenal Fatigue
 Lifestyle factors
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Nutrition: Low sugar and not skipping meals
Stress Management: physical and emotional
Sleep - 7-9 hours
Exercise - not too much or too little
Remove toxins - caffeine, alcohol, drugs,
environmental
 Targeted Supplementation
Adrenal Supplements
 Herbs, including Rhodiola - adaptogen
 B5, B6, Vit C
 L-tyrosine - especially good for
depression, low energy
 Licorice root - especially for
inflammatory conditions
Mind-Body Techniques
for Balancing Stress
Hormones
 Relaxation
 Breathwork
 Autogenics and
Biofeedback
 Meditation
 Imagery/Self-
hypnosis
 Exercise
 Prayer
Bone Building
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Estrogen
Testosterone
Raloxifene
Calcitonin
Exercise
Sunlight
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Vit D
Calcium
Magnesium
Boron
Strontium
Orthosilisic Acid