During the reproductive years, women undergo many changes. This period starts from menarche and ends at menopause. The female reproductive organs, the ovaries, secrete important hormones like estrogen and progesterone. These two hormones are the major contributors in developing female sexual characters and in maintaining their menstrual cycle. However, there are other hormones which are equally important in the prior mentioned roles.
This network works in the hormonal circuit starting from the hypothalamus to the pituitary to the adrenal gland and finally acting on the gonadal axis releasing hormones. The role of these hormones is highly significant in maintaining the menstrual cycle. (1)
What is hormone optimization?
Hormone optimization refers to the estimation of declining levels of the hormones in the body and its overall threshold. The aim of optimizing these hormones is to suggest alternative options like hormone replacement therapies to improve the symptoms for the patient. Lifestyle changes like weight loss in obese patients and dietary changes are also advised. (2)
Role of gut microbiome in estrogen metabolism
There is a specific type of gut bacteria that plays an important role in hormonal balance in females. This is known as estrobulume. This class of bacteria that is present in the gut regulates and excretes estrogen in the body. It does this by producing a hormone called beta glucuronidase which prevents excess excretion of estrogen in the gut. However, if this hormone is overproduced it will cause dysbiosis and estrogen dominance in the body. This can be detected by blood or stool samples. It has been noted that women who have an estrobolme that causes estrogen dominance predisposes them to diseases like breast cancer, endometrial cancer and prostate cancer in men. (3)
Intergenerational trauma and its effects on the endocrine system
In many individuals, more commonly in females, the effects of emotional trauma can be passed on to their future generation. Their descendants are more susceptible to depression and other psychiatric disorders. They may present themselves with behavioral challenges and difficulty in problem solving. Trauma is passed via genes or through the behavior of mothers towards their children which impacts their development. It is greatly observed in females living in warzones (4). It affects their problem-solving abilities and their willpower to get through difficult situations.
The above-mentioned factors also influence the endocrine system. The hypothalamic pituitary gonadal axis is disturbed which causes hormone imbalance that can present as over or underproduction of certain hormones. It predisposes the females to conditions like endometriosis, fibroids and polycystic ovarian syndrome. I can also attribute to constipation which is generally more in females than males. (5)
Hormone optimization options for women
A significant option for hormone optimization is Hormone Replacement Therapy (HRT). It is offered to post-menopausal women who are experiencing symptoms like hot flushes, mood swings, dry vagina, insomnia, vasomotor symptoms and osteoporotic symptoms (6). It is usually offered to women after their symptoms appear. However, experts like Dr. Sara Gottfried believe that women should be counselled and offered HRT in their premenopausal years which can prevent them from developing these symptoms in the first place and as provide maximum effect. This is the time when the estrogen levels begin to decline hence the HRT is most beneficial.
Before starting the therapy, it is very important to identify the hormones that are deficient which can be replaced accordingly. Surgical and medical history helps in determining the type of HRT to be used.
Types of HRT
There are two major types of hormone replacement therapies,
- Combined HRT
This typically has estrogen and progesterone. This type of HRT is ideal for women who have an intact uterus as progesterone protects the uterine lining from the stimulating effects of estrogen. This therapy can be given intermittently or continuously. This is available in the form of pills, patches and coils. (7)
- Estrogen only therapy
This comprises of estrogen as the only hormone. It is preferable for women who have undergone hysterectomy (removal of uterus) since the proliferative effect of this hormone is ineffective. It is available in many forms like tablets, implants, patches, rings, gel and spray forms. (8)
There are certain medical conditions that may alter the indication and dose of HRT. Such conditions include breast cancer, uterine cancer, ovarian cancer, cardiac diseases, hypertension, liver disease, pregnancy and breastfeeding.
Conclusion
In conclusion, the various symptoms that women undergo throughout their reproductive years were rendered uncontrolled in the previous times. However, in recent times, the discovery and application of alternatives have minimized such inconveniences. These symptoms begin at menarche and continue till after menopause. The detrimental effects of menopause can be avoided by opting for appropriate measures in diet and lifestyle. Another alternative that can be offered is hormone replacement therapy, which has gained popularity in recent years. It saves women from declining estrogen effects after menopause and aids them in living a healthy life.
References
- Christensen, A., Bentley, G. E., Cabrera, R., Ortega, H. H., Perfito, N., Wu, T. J., & Micevych, P. (2012). Hormonal regulation of female reproduction. Hormone and metabolic research, 44(08), 587-591.
- Gottfried, S. (2014). The hormone cure: Reclaim balance, sleep and sex drive; lose weight; feel focused, vital, and energized naturally with the Gottfried protocol. Simon and Schuster.
- Baker, J. M., Al-Nakkash, L., & Herbst-Kralovetz, M. M. (2017). Estrogen–gut microbiome axis: Physiological and clinical implications. Maturitas, 103, 45-53.
- Bowers, M. E., & Yehuda, R. (2016). Intergenerational transmission of stress in humans. Neuropsychopharmacology, 41(1), 232-244.
- Higgins, P. D., & Johanson, J. F. (2004). Epidemiology of constipation in North America: a systematic review. Official journal of the American College of Gastroenterology| ACG, 99(4), 750-759.
- Barrett-Connor, E., & Stuenkel, C. A. (2001). Hormone replacement therapy (HRT)—risks and benefits. International Journal of Epidemiology, 30(3), 423-426.
- Udoff, L., Langenberg, P., & Adashi, E. Y. (1995). Combined continuous hormone replacement therapy: a critical review. Obstetrics & Gynecology, 86(2), 306-316.
- Tannen, R. L., Weiner, M. G., Xie, D., & Barnhart, K. (2007). Estrogen affects post-menopausal women differently than estrogen plus progestin replacement therapy. Human reproduction, 22(6), 1769-1777.
