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HORMONAL DYSFUNCTIONS

75% of women suffer from PMS (premenstrual syndrome) and PMDD (premenstrual dysphoric disorder). The infertility rate is soaring and the vastly increased numbers of cases of early puberty, fibroids, endometriosis and cystic disorders all indicate an aberrant imbalance in hormonal function. Though there are many influential factors involved, the predominant core imbalance is estrogen metabolism dysfunction.

One of the most common mistakes in dealing with hormonal issues is the limited view that the dysfunction must be the hormone itself. By artificially rearranging the hormone levels via external intake through pills, patches or creams, one can help an individual feel better temporarily, but in the long run there has been no correction to the original physiological imbalances responsible for the estrogen problem. This appears to be verified by the set of problems disclosed in the recent women’s health initiative study. The study was ended prematurely due to the warning signs and increases of HRT-related dysfunctions.

To make the proper corrections it is important to recognize all the variables that influence estrogen metabolic imbalances.

The following disorders have estrogen metabolism dysfunction as a primary influence. At the end of these descriptions, there is information outlining the 4 major areas of physiology involved with estrogen imbalances. Even though each dysfunction has its own separate set of symptoms and difficulties, estrogen metabolism inadequacies usually remains at the center. If other factors are strongly involved, it will be noted where it is appropriate.

P.S. Frequently doctors tell their patients to wait until after menopause, if possible, to see what transpires. Often the problems lessen or seem to almost disappear. This strongly indicates the influence of estrogen on the problem because after menopause estrogen production noticeably declines. However, the original problem was not with the production of estrogen but the body’s inability to break it down and eliminate it efficiently. Once there is less estrogen in the system, the body’s load to metabolize it properly is greatly reduced. Thus the symptoms are reduced as a consequence. But the physiological problems that lead to the ineffective breakdown and elimination of estrogen still exist and can lead to other dysfunctions or diseases later in life.

ENDOMETRIOSIS:

This is an overgrowth of the endometrial cells that line the uterus. As endometrial tissue grows, cell can be found outside the uterus. There are many theories for this development but none has proven to be valid up this point in research.

Approximately 10% of the women (more than 12 million) in this country have endometriosis. It is implicated in 25% or more of the cases of infertility. It is often accompanied by ovarian cysts and is characterized by the following symptoms:

Uterine pain
Abdominal pain caused by adhesions
Low back pain
Pain throughout the menstrual cycle
Excessive bleeding; clots and tissue may be part of it
Nausea
Vomiting

FIBROCYSTIC BREAST DISEASE

This denotes the presence of tender, non-cancerous nodules in the breast tissue. This is found in 50% of the premenopausal women. New cysts do not appear after menopause (this indicates the influence of estrogens). Along with dietary changes recommended at the end of these descriptions, methylxanthines have a strong impact on cyst development. This is found in caffeine, tea, cocoa and asthmatic medication.

FIBROIDS

This describes non-cancerous growth of fibrous and muscle tissue in the uterous. Approximately 40% of women at age 40 have some form of fibroids. After menopause, these growths shrink and in some cases totally disappear. Fibroids have been implicated in infertility and are characterized by the following symptoms:

Increased bleeding
Prolonged periods
Decreased frequency of menstrual cycles
Bleeding between periods
Pressure and/or pain in the uterine area
Painful intercourse

PREMENSTRUAL SYNDROME (PMS)

This describes a group of symptoms relegated to the second half of a women’s cycle. It is estimated upwards of 75% of women experience this at some time in their life and it typically peaks between the ages of thirty and forty. In 10% of the cases it is so severe that it interferes and interrupts their daily lives. Some women can not even carry out the minimal daily activities required. Many women have been told by their practitioners it is a psychological problem but it is a true biochemical imbalance.

Physical

Bowel changes-diarrhea around time of period
Brest swelling and/or tenderness
Increased size of breast nodules
Swelling of feet and fingers
Abdominal bloating, cramps or distension
Acne
Headaches/Backache/Abdominal pain
Weight gain
Sleep disturbance
Cravings for sugar, especially chocolate. Secondarily for salt and fats
Emotional/Mental (when this is severe during the two weeks only it is termed PMDD)

Anxiety
Depression
Mood swings
Irritability
Difficulty with focusing, memory and concentration
Lethargy
Outbursts of anger
Suicidal/homicidal feelings in very severe cases
Changes in libido

MENOPAUSE

When a women’s period stops for a minimum of 6-12 months she is considered to be in menopause. Prior to this, she may have erratic cycles, start to notice some body changes 1.e. change in body hair, breast tissue, weight distribution, and the beginning of some of the symptoms experienced during menopause. This is called perimenopause.

As a woman enters menopause there is a decrease in the production of hormones, especially estrogen. During this change, the adrenal glands become the source of estrogen production for the women. It produces a hormone called DHEA which goes through a series of chemical reactions and is converted to estrogen. When this organ is not capable of carrying out this function or there is some inhibition or interference with the conversion process, the symptoms of menopause manifest. Some studies state symptoms occur because a part of the brain involved with regulating the hormonal cycle changes. Others believe it is due to an estrogen flux. Whichever factors are involved with each person, they are part of the same factors involved with poor estrogen metabolism.

65%-80% of women experience symptoms during menopause. These include

Hot flashes
Headaches
Night sweats
Vaginal dryness-antihistamines, diuretics, caffeine and alcohol can cause this
Forgetfulness
Decreased concentration
Sleeplessness

In many other cultures, menopause is revered part of life that is held in high esteem. In our culture where eternal youth is exalted and aging deemed unacceptable, there can be social-psychological factors that trigger some of these symptoms for a certain percent of women.

POLYCYSTIC OVARY SYNDROME (PCOS)

This is one of the most common disorders in menstruating females and infertility. It is characterized by an increase in androgens (male hormones), bilateral ovarian cysts, possible loss of period and the inability to ovulate.

Symptoms include the following:

Irregular periods
Acne beyond puberty
Facial hair
Hair loss
Unexplained weight gain
Inability to lose weight
Fatigue
Mood swings
Fluid retention

It seems there are several variables that promote this dysfunction. Foremost, insulin resistance shifts the body into androgen (male hormones) excess. In turn, this excess promotes the insulin resistance. A vicious feedback cycle now occurs between the two functions and becomes self-perpetuating. It appears the way insulin resistance increases the androgens is by affecting an enzyme that increases the production.

This same insulin resistance increases the levels of estrogen in the body which can also increase androgen production.

Another mechanism involved with PCOS is a defect in the feedback mechanism between the brain (hypothalamus) and the hormone production ability of the woman.

Other factors are genetics, premature onset of menstruation, androgen production from other sources i.e. the adrenal glands and decreased fetal growth.

The most critical step to correct this dysfunction is to minimize or eliminate the insulin resistance and any underlying habits and causes that may be promoting it. See articles on sugar regulation and stress.

FACTORS AFFECTING ESTROGEN METABOLISM

Hormones go through three stages. First they are produced by the organ of origin and supporting structures i.e. estrogen is produced by the ovaries and later in life by the adrenal glands. The same is true of progesterone.

Second, the hormones must travel to the designated cell, hook up and deliver its message to the cell so its function can be carried out. Each cell has a specific area on its membrane called a receptor site. This is the location where the hormone hooks up to the cell. The receptor site is configured to receive its related hormone. It will not allow a different hormone to attach itself. It works very similar to a “lock and key” model. If this location is not available, the hormone can not attach to the cell and deliver its message. Whatever function is supposed to be carried out goes unfulfilled.

The final stage is the breakdown and elimination of the hormone. After it completes its job at the cell membrane estrogen must be transported back to the liver to be broken down into an inert compound then excreted in the feces.

Whenever we deal with estrogen metabolism dysfunctions, there are primary areas of physiology that affect the three stages previously mentioned. The vast majority of the problems occur in stages 2 and 3. Proper production of estrogen is usually not a core issue. It can occur in response to genetic abnormalities or in response to a tumor, but it generally is reflective of an imbalance in the other two stages. When dealing with estrogen-mediated problems we must always direct our attention towards 4 areas of function. In each of these areas we will explain the relationship to hormonal problems.

1) Detoxification: All toxins produced by the body’s own metabolism and those taken in by the body from our food, water, air and drugs (recreational and medicinal) must be broken down into inert compounds for elimination. Estrogen goes through 3 basic steps. First, it goes through Phase I. This process is called hydroxylation. The by-products (metabolites) are known as hydroxyestrrogens and they are toxic. There are various forms of these hydroxyestrogens and some of them are directly involved in not just the hormonal-related problems but numerous forms of female cancers and cancer involving bone, intestines, brain, kidney, genitor-urinary tract, liver, testes and prostate. (There is now a urinary test that can examine some of the ratios of these hydroxyestrogens and determine if you are at a higher risk for some of these dysfunctions.).

Phase II of detoxification involves a process known as methylation. If this stage is inadequate, the body will have an excess of hydroxyesrogens and pre-dispose the individual to a greater risk of estrogen-mediated diseases. If this stage is able to complete its function, the estrogens go to the final stage known as conjugation. Here is where the breakdown of estrogens is completed, excreted into the gall bladder with the bile, to later be eliminated in the feces. If there are any difficulties with the gall bladder, even if the estrogens are broken down, the inability to eliminate them can lead to hormonal problems as well as gall stones and digestion difficulties. See article on detoxification for more details.

If there are incomplete forms of estrogen breakdown products at any stage, they can be re-circulated. They will attempt to get to the cell membrane and hook up. When they arrive, because they are only a partial match to the receptor site, a regular signal to the cell does not occur. Instead a partial signal is transmitted and the regular, normal function of estrogen is not carried out. What transpires is a make-shift action unlike estrogen. This results in a distorted response which can account for some of the symptoms and problems experienced in the aforementioned dysfunctions.

See article on detoxification

2) Digestion: The ability to properly breakdown foods and absorb the nutrients is critical to the welfare of everybody. Imbalances in this system can have exponential affects in regards to almost every health problem. Specific to estrogen problems the following possibilities must be reviewed

A) Parasites and candidiasis: These pathogens give off toxins from their own metabolism that favors the production of the unhealthy hydroxyestrogens.

B) Beta-glucoronidase. This is an enzyme located in the intestinal tract and can remove estrogens from the feces and re-circulate them back into the body, increasing the amount of estrogens in the system. This puts an extra burden on the liver to break it down again. This enzyme tends to be elevated in individuals who overconsume red meat and saturated fats.

C) Indigestion: If there is any difficulty breaking foods down certain necessary compounds that help control estrogen metabolism will not be absorbed. This is very important with those individuals who have trouble with vegetables. Vegetables, especially the cruciferous vegetables, have a compound called indole-3-carbinole. It functions by converting the unhealthy hydroxyestrogens into mild forms of hydroxyestrogens for further breakdown.

D) Inability to move ones bowels regularly (minimum once-a-day) increases the toxicity of the bowel and puts and extra burden on the liver for detoxification. This may impede its ability to detoxify other substances including hormones.

E) If you take isoflavones to help with your symptoms and you do not receive any benefits from them, it is an indication of a bowel problem. This is because a healthy bowel activates the isoflavones to carry out their function and decrease the symptoms of estrogen related problems. If there is no affect, it indicates a lack of conversion. This must be related back to a bowel functioning at less than full capacity.

3) Blood sugar regulation & adrenal stress: These two functions are intricately linked. Under stress, whether it is mental/emotional, physical or biochemical i.e. bad diet and environmental toxins, there will be a rise in the adrenal hormone called cortisol. Its main job is to maintain a healthy blood sugar level at all times. It will even do it at the sacrifice of other bodily functions. If cortisol stays elevated for an extended period of time it will:

*Decrease detoxification capacity

*Decrease the immune system in the digestive tract. This will allow for parasites, candida an other pathogens to multiply.

*Increase indigestion-this leads to a decrease in nutrient intake

*Alter the composition of the cell membrane and receptor site. This will make it difficult for the hormone to hook up and relay its messages accurately.

*Create insulin resistance

Insulin resistance denotes the cells inability to accept the sugar molecule it requires for energy. When we consume foods, they are broken down into fats proteins and sugars. These sugars stimulate the release of insulin. The insulin attaches itself to the sugar molecule and proceeds to carry it to all the cells of the body that require it. Once it gets to the cell, it must link up to a designated receptor site for insulin (this is similar to what estrogen and many other body chemicals must do at the cell level). If the cell membrane and receptor site are unable to readily accept the insulin it is called insulin resistance. When this happens, the cell does not get its required sugar molecule and numerous chain reactions and consequences ensue.

Specific to estrogen, insulin resistance will:

*Decrease detoxification

*Increase estrogen levels

*Increase obesity-with obesity, the fat becomes a repository for secondary

estrogen production. This will increase the total amount of estrogen in

the body.

*Increase cortisol production and its affects mentioned above

*Alter hormone synthesis to androgens, resulting in PCOS

4) Essential Fatty Acid Metabolism: Fatty acids make up the cell membrane composition. The receptor sites are formed from proteins. When the balance of fatty acids in the membrane becomes altered, it affects the function of the receptor site for all chemicals. This change is caused by:

*Poor food choices-refined carbs, vegetable oils and trans-fats

*Elevated cortisol levels

*Insulin resistance

*Nutrient deficiency

*Steroids, corticosteroids, NSAIDS and birth control pill

*Free radical production

*Dairy products, alcohol and saturated fats

Once the cell membrane’s configuration is altered cell signaling is compromised. The cell can not take up the hormone and transmit its signal properly.

Inflammation occurs as a result of the fatty acid imbalance and is directly responsible for the menstrual cramps a woman experiences.

The change in fatty acids perpetuates the insulin resistance and cortisol production. Now it is part of a negative feedback cycle that maintains its altered function.

Correction requires re-balancing the omega 3, 6 & 9 fats.

This is a brief overview of estrogen metabolic dysfunction. Correction of these four areas can result in amazing changes in a woman’s health. Obviously dietary changes are a large part of the solution. Without getting into specifics, because each individual must be treated accordingly, research shows that steady changes towards a vegetarian diet has a remarkable impact. For most people, this means to increase your vegetable intake to 4-5 servings a day with lots of leafy greens added. Reduce saturated fats and increase fish intake. Use low-sugar fruits with nuts and seeds for snacks. Eat organic as much as possible to eliminate the intake of hormone and antibiotics in the meats and to reduce the consumption of chemicals, pesticides, herbicides etc. in our produce.

There are currently 75,000 man-made chemicals in the environment. This places a huge burden on the liver for detoxification. !7,000 of those chemicals are xenoestrogens. That means these substances, when they enter the body will act like estrogen to some degree. It can change cell signaling, alter membrane fatty acid ratios and again put an undue burden on the liver. Take whatever steps are necessary to eliminate these toxins from your life.

Every pro-active step you take will move you one step closer to optimal health.