Chapter 4: 3 Health Issues that Masquerade as Hormonal Imbalance (and how to know)
Different Delivery Systems
As far as delivery systems, this is another difference between a compounding formula and a traditional conventional formula. There are creams using Bi-est, meaning 2 estrogens, estradiol, and estriol. This cream is probably the most common form of estrogen used. Using a cream is preferable because it well absorbs ed when it’s applied properly to the thinnest skinned areas of the body like wrists, behind the knees and tops of feet.
Lozenges, or troches, are another delivery system. These are basically placed in the mouth next to the mucosal membrane, which is the inner cheek for absorption into the bloodstream.
Other ways of delivering hormones include injections (particularly for testosterone) as well as pellets. These subdermal pellets are basically an incision in the hip where hormones are placed for a 3-4 month time span. This delivery system yields mixed results with patients. Of all of the delivery systems mentioned, creams are preferable, but lozenges may be a good option for patients who have not seen any benefits after using creams.
Safe Use of Hormones
There are some safety precautions to consider in the use of hormone replacement therapy.
- A family heastory of breast cancer. If there is an estrogen receptor or a progesterone receptor-positive for breast cancer in your mother, hormone therapy would not be advisable. While genetics don’t dictate everything, there are many other ways to have relief during menopause without doing hormone therapy. Likewise, if there’s a personal history of breast cancer, hormone replacement therapy would be advised.
- Oral Estrogens. Oral estrogens imply a capsule that is swallowed and refers back to the conventional way of receiving hormone therapy. Estradiol, when swallowed, can trigger clotting factors and can also provoke some of the inflammatory markers, which can be tested for through a blood test called C vessels, and in turn, can increase the risk for heart attacks and strokes. Because of the connection between oral estrogens and increased CRP, it would be advisable to consider something safer if you are currently using oral estrogens.
Progesterone can be a fantastic hormone to use and sometimes when women are going through menopause, they can handle all of their symptoms with herbs. However, some women struggle to achieve a good quality of life with herbs alone, which is when it may be necessary to resort to hormonal therapy. Some women do great just using progesterone, especially if the issue is insomnia. Progesterone is typically produced in the women’s body when experiencing normal cycles prior to menopause. Usually, it is promoted in the body for two weeks out of the month. However, when ovulation and regular cycles are no longer occurring, the production of progesterone really declines, and hence. The benefits provided by that progesterone are lost. Progesterone, when broken down by the body, turns into a metabolite that binds to receptors in the brain, called Gamma-aminobutyric acid, or GABA, is a brain chemical that helps with anxiety when it’s 2promoted properly and it can help with good quality sleep. When levels of progesterone are low, which naturally happens with menopause, some menopausal issues could be removed with the use of progesterone via hormone replacement therapy. Progesterone, like estrogens, can be made up in a cream form. It can be also used conventionally, meaning you can get it at traditional pharmacies such as Walgreens or CVS. Progesterone is bio-identically and also comes in a pill form which can be even more sedating than other forms. This option may be especially helpful when dealing with insomnia. Progesterone will often be prescribed if an individual is already using estrogen as the progesterone decreases the risk of cancer in the uterus. If you have had a hysterectomy, and therefore no longer have a uterus, not all of these recommendations may apply to you.
Testosterone can also be used as an option in hormone treatment for someone who has low libido, fatigue, and low testosterone levels in the blood. Like other hormone replacement treatments, testosterone is available in various forms. In situations where multiple hormones may be needed, everything can be added into one cream.
3 Health Problems that Masquerade as Hormonal Imbalances
While there are many health issues that can masquerade as hormonal imbalances, there are three in particular that are pertinent to the discussion surrounding menopause:
- Adrenal and thyroid dysfunction
- Digestive issues
- Food intolerances or allergies
There are many patients who do fantastic with just herbal remedies, but there are also those who don’t improve with high doses of hormone replacement therapy, which means something is missing and could very well be attributed to one or more of these three health problems. Depending on presenting symptoms, these health concerns may be something to investigate regardless of the state of hormonal balance.
When adrenal or thyroid dysfunctions are present, there can be many symptoms that result. A common contributing theme to symptoms is stress, especially when it comes to these two glands. The adrenals are small glands that sit on top of the kidneys and produce a multitude of hormones:
- Adrenaline- This includes norepinephrine and epinephrine, both of which are pumping through the veins when under stress or experiencing anxiety.
- Cortisol- Cortisol, when overproduced, can contribute to weight factors and can also induce fatigue when levels are either too high or low.
- DHEA- DHEA (Dehydroepiandrosterone) is another important hormone because it helps make estrogen and testosterone.
So, when experiencing increased feelings of stress and being overwhelmed, and healthy coping mechanisms aren’t in place, the adrenals really start to feel it. Individuals may experience increased anxiety and discomfort as a result. As high levels of stress continue over time, it starts to really wear on the function of this gland. This process with the adrenals can belikened to a wet cloth. When you wring out a wet cloth, you’re wringing it out and wringing it out, and eventually, run out of water. Likewise, when the adrenal glands continue to be overworked, there’s really not as much that the body can do when this gland can’t give to the body anymore and will begin to significantly affect cortisol levels.
As far as testing for adrenals specifically, saliva cortisol testing is the most accurate test as it is going to evaluate what’s really going on throughout the course of a complete day. Typically, a saliva sample is collected in the morning, mid-day, late afternoon, and before bed to ensure the cortisol is starting at a high level in the morning and then slowly declining to a low throughout the day. If that’s not happening, then the individual is most likely not feeling well and there are some very specific things needing to be addressed. In some instances, it is necessary to do a cortisol AM and blood test because insurance won’t cover the saliva cortisol test. This method of testing gives some information and there is value in that. However, the saliva cortisol test is of the most benefit. Also, DHEA-S tests can be done via blood testing and can information in regards to good DHEA levels and DHEA helping the estrogen and testosterone to be more adequately produced in the body.
Cortisol should be highest in the morning, so when getting out of bed, energy is good. As the day progresses, cortisol levels slowly decline so by night time it’s low and should allow for the ability to fall asleep and stay asleep. This cycle, or the perfect rhythm, is called Circadian Rhythm of the Adrenal Function. However, both Stress and age wear the adrenal gland down and so the cortisol is no longer able to be produced at the necessary levels in order to help with energy and proper sleep, and poor sleep will lead into a vicious cycle. Also, cortisol is a natural anti-inflammatory so some individuals with low cortisol levels can have more achiness because the cortisol cannot put out little fires here and there. So, again, this can be a major factor for one’s health if it’s not being addressed.
As mentioned previously, DHEA is extremely important because it makes estrogen and testosterone. In fact, 60% of hormone production, after the ovaries decline in their output, revolves around the adrenal glands’ ability to make DHEA because the DHEA produces more estrogen and testosterone for the body to utilize. DHEA is important to check even in younger women who aren’t even close to menopause, DHEA is an important tool for multiple reasons but especially to help ease the transition into menopause or to ease discomfort for those in the midst of menopause.
Adrenal and thyroid function go hand-in-hand, so if there is an adrenal issue, then there is a thyroid issue and vise versa. Common thyroid symptoms, particularly for hypothyroid or low thyroid, would include irregular menstrual cycles, fatigue, inability to lose weight, hot flashes, cold intolerance, or temperature regulation issues can be wrapped around hypothyroidism. There is also the more rare occurrence of hyperthyroidism, which can cause heart racing and hot flashes, both of which are common to menopause. Testing would help to identify if there are issues with a thyroid imbalance. Individuals should have annual testing done for at least TSH (which is a brain signal to the thyroid gland), Free T4, and Free T3. There are other tests that can be done to give us more information like Reverse T3 (although insurance sometimes doesn’t cover that) as well as Anti-TPO and Antithyroglobulin Antibodies which both help in diagnosing Hashimoto’s. Hashimoto’s is an autoimmune disease where the immune system turns on itself and starts attacking its own thyroid, which over time causes a decline in thyroid function and can be why someone becomes hypothyroid. If this testing comes back positive for the Hashimoto’s antibodies, further investigation is required to find out why the immune system is attacking the thyroid. This includes looking at other issues such as food allergies, gut function, and environmental factors that are contributing to the development of Hashimoto’s. If these are issues, it is best to treat them using herbs if possible.
Herbal combinations that are helpful for the adrenals are formulas containing:
- Siberian ginseng
- Holy Basil
Vitamin C is also an extremely important nutrient for the adrenal gland. If DHEA is low, then it needs to be replaced in the body while healing the adrenal glands. DHEA can be prescribed at doses anywhere between 5-50mg. It is best to be able to do it at the lower end of 5 or 10mg to decrease any negative side effects that can occur like acne or hair loss, which could already be issues when someone is going through menopause. Sometimes when the adrenals are really depleted or someone is physically depleted, IV therapy can be a great benefit as well, particularly high doses of Vitamin C just because the intestinal tract can’t tolerate too much Vitamin C without causing loose stool, so Having it given intravenously can really help speed up the process. Other actions that can be taken to be proactive in helping include stress management, seeing a therapist, talking with friends, regular exercise, promoting a good sleep routine, avoiding computers and other screen time before bed and sleeping in a dark room.
The next category of health issues that can masquerade as hormonal imbalance has to do with the digestive tract. Common digestive issues that can happen at any time in life but that might be seen more in menopausal women would be bloating:
- Irritable Bowel Syndrome (IBS)
- Frequent Diarrhea
- Multiple bowel movements in a day or after meals
There are different underlying causes as to why these issues may be present. Difficulties such as weight gain or inability to lose weight can also be a result of digestive issues. Digestive issues can definitely slow metabolism, which contributes to weight gain or inability to lose weight. When digestive problems are the root cause of the weight challenges, hormone therapy is not going to fix it and other means are necessary to get the metabolism to click a little more and aid in the weight loss aspect. Digestive issues can also be connected to mood issues such as depression and/or anxiety and can also be connected to increased inflammation. Therefore, many people who have arthritis or other inflammation-related conditions may see improvement by working to heal the digestive tract.
There are three areas to investigate when first addressing digestive issues:
- Small Intestinal Bacterial Overgrowth
Candida Albicans typically referred to simply as Candida, is in everyone’s intestinal tract along with bad bacteria and hopefully good bacteria. Problems occur when Candida levels become elevated, an imbalance of the gut flora occurs, and the body breaks down the Candida and turns it into alcohol in the bloodstream.
Candida can get too high through a variety of ways:
- Use of oral birth control
- Extensive use of antibiotics which kills off the good bacteria, steroid use
- Steroid use
- Carbohydrates and sugar of any kind which stimulates the growth of Candida Albicans
These elevated Candida levels can result in fatigue, inability to lose weight loss arthritis, and mood issues.
Small Intestinal Bacteria Overgrowth, or SIBO, can happen for a few different reasons. Ultimately it boils down to bacteria being present in the small intestine, where it doesn’t belong. The small intestine should be a sterile place where nutrients are absorbed to be utilized by the body. SIBO occurs when, instead of the small intestine remaining a sterile place, bacteria that travels through during digestion and it gets to the small intestine and stays there. As a result, the bacteria start eating the foods that you’re eating and start releasing gasses. These gases can affect us digestively. In fact, about 70% of IBS is related to SIBO. SIBO can interfere with the absorption of nutrients and hence the proper nutrients aren’t getting to the body’s cells for proper use. Some of the resulting symptoms include bloating, pressure on the top of the stomach, extensive belching, and fatigue. SIBO has also been connected to fibromyalgia which causes increased pain and tenderness in the body in addition to tiredness and can cause weight gain and hair loss.
Most people would probably never ever consider the possibility of having parasites, especially if they never traveled outside of the United States. However, Even in the United States, the contraction of parasites is possible. Dogs and sushi both carry worms and parasites and again, if you are someone who travels outside the country, you could be exposed to parasites from other sources. Symptoms of parasites can include:
- Weight gain
- Hot flashes
- Night sweats
So, while some of these symptoms just may seem to be a normal part of the menopausal process, further investigation may reveal there’s more to the story.
A Stool test can confirm if someone has either Candida or parasites. A SIBO test is a breath test in which you are given a solution to drink. You then have to breathe into different tubes over a 2-hour time frame. If you are positive for SIBO, a gas called ethanol hydrogen will be present and collected in the tube. The laboratory will analyze the sample to see if those gasses are present. Ultimately, if Candida, SIBO, or parasites are present, these underlying issues masquerade as menopausal symptoms will need to be addressed as they may not be connected to the hormonal imbalance whatsoever.
When there is a dysbiosis or an imbalance in the digestive tract, it will typically create inflammation in the intestinal lining, and therefore cause a propensity to have food sensitivities. Of course, when eating something your body doesn’t like, you are going to feel even worse. Similar to the other health concerns already discussed, issues with food sensitivities and/or food allergies can lead to difficulty with weight loss and achy joints. The three most common food allergies are:
- Bakers and brewers yeast
Some people may be frustrated because while they are striving to eat healthily, they continue to gain weight. This can happen because while they’re eating something that is, in theory, healthy, it may not be healthy for their body. Doing a food-sensitive test will be helpful in such instances as it provides a great deal of information as far as the individualization of the reaction of various foods specific to that person. This testing can look for 90 different food reactions, including Candida. Another way to assess for potential food sensitivities is simply eliminating the most common food sensitivities such as wheat, dairy, yeast, and sugar (as sugar creates inflammation and can stimulate Candida yeast in the gut).
When food sensitivities or allergies are identified, it is advised that the individual then avoid those foods and watch for improvements in symptoms. It is recommended that a person avoid the identified foods for at least eight weeks, as it does take time for the body to detox and fin an established balance. If someone has many different food sensitivities, then their gut will be inflamed, and therefore may require harder work to get them in balance. Simultaneous herbs may also be necessary based on the severity of the food testing results.
Often times, some of the eliminated foods can slowly be added back into the diet to assess if it’s no longer an issue or continues to trigger symptoms. If the food allergy or sensitivity remains, it ultimately becomes a choice as to whether you will continue to avoid the food or continue eating it and then deal with the associated consequences.
Chapter 5: Action Plan
Action Plan to Feel Amazing
The action plan recap to feel amazing in menopause:
- Eat “YES!” foods every day.
- Avoid “NO!” foods as much as possible.
- Consider your stress triggers and start a new habit to reduce stress.
- Practice good sleep hygiene.
- Try one of the top herbal remedies for menopause.
- Talk with a doctor about natural hormone replacement if you think that’s right for you.
- Get evaluated for hidden health issues.
If you implement even one of the ideas discussed in this ebook, you’ll be on your way to feeling more amazing in menopause!
Author’s Note – Jennifer Nevels
I work with women like you in my office every day. When I work with patients one-on-one, we’re able to get more specific in identifying your health issues. When you come in for a visit with me we explore your health history and choose lab tests that are most relevant to better understand your physiology and make individualized recommendations for nutrition, dietary supplements, and hormone replacement if needed. In order to explore your individual needs, I invite you to schedule an initial consultation with me today. Thank you for taking the time to read the information presented here. My passion is really helping women as you transition gracefully through the phases of life. Have a great day!
More Tips on feeling amazing in Menopause
For more information on dealing with your menopause click this link to see other chapters of this audiobook:
If you’ve got more questions about how to feel amazing during menopause, we’d love to meet with you and help you find relief in this difficult time in your life.