Every woman knows it.  We all complain about it.  We will all tell our doctors about it at some point in our lives hoping they will help us.  Unfortunately, most doctors just don't get it.  What is the "it" that I am referring to?  I am talking about the impact of our hormones on our moods, energy levels and eating habits.  If you are a woman then I guarantee you will relate to the following:

Have you ever felt as if you have been invaded by an alien being for two weeks out of every month that makes you act in ways you would never even consider the previous two weeks?

I hear about it every day in my office and I have experienced it myself.  We are not crazy.  The impact of our hormones is very real and can completely disrupt our lives.  It is time to get some clarity on this issue and become well-informed patients so that we can become active participants in our own health care.

First we must understand what hormones are and what they do.  Hormones are very potent chemical messengers with receptor sites in every cell of your body.  Each has their own personal set of instructions to give to their target cells and the instructions are all connected to one another to keep our bodily functions and systems in balance.  When everything is in balance it is like an orchestra playing in perfect harmony.  Unfortunately, when one player is out of tune it can get ugly. 

Most of us are aware of the impact of thyroid hormones and I would bet that most of you reading this have had your thyroid levels tested at some point.  I am sure that you were convinced your thyroid had to be the cause of your weight gain and low energy.  I would also bet that your test results came back within the normal range and you left the doctor's office feeling more dismayed than ever before.  But what if it actually was your thyroid despite the apparent normal lab result?  Maybe your numbers were within the normal range but were not optimal.  See, symptoms of hypothyroidism and weight gain can occur in the early stages of thyroid decline and long before your TSH levels show that a problem exists.  Mine were technically normal but my doctor spotted that my T4 was not converting to T3 and that my low normal T3 levels caused my symptoms.  A prescription for T3 changed my life.  I could get out of bed again in the morning feeling refreshed, I wanted to go to the gym again, I was no longer cold all of the time and my hair finally stopped coming out in clumps.   Clients of mine have had apparently normal thyroid levels but when they had a thyroid binding globulin test done they discovered that their bodies were producing antibodies that were attacking their thyroid gland.  The result of this antibody attack is a form of hypothyroidism known as Hashimoto's Disease.  Once again a prescription for thyroid medication helped them to reclaim their lives like me.  The scary thing is that most doctors do not even order that test to be done.  The patient must request it.  That does not make sense to me at all.  Why would a doctor leave out one of the pieces to the puzzle?  Probably because the test is more expensive than the others and maybe he is actually unaware that the test even exists because he is not a hormone specialist.  Most of us, however, do not go to specialists for thyroid testing but rather request it from our primary care physician.  Do yourself a favor.  When requesting a thyroid test panel, be sure to request Free T3, Free T4, TSH and thyroid binding globulin tests in order to get the complete picture.  Then be prepared for the possibility that your doctor may not be comfortable with the complexities of your thyroid and may stick to the standard protocol based on normal ranges.  A normal range, however, is just that?a range.  That means different people feel differently at different points on that range.  Your doctor must take into account how you feel along with the results.  If he doesn't, then seek out a new doctor.  Now that said, you must be aware that your thyroid hormones may not be the right hormones to point your finger at when blaming hormones for the way you feel. 

Aside from thyroid hormones, ovarian hormones must be in balance for women to feel their best.   If your estradiol levels are low then your body temperature can be low (a normal symptom of hypothyroidism and the so-called "Wilson's Syndrome") and no matter how much T3 you take it won't bring up your body temperature.  Imagine cranking up your T3 dose in an effort to bring up your body temperature while simultaneously having low estradiol levels that are undetected.  That would be easy to do if you never test your ovarian hormone levels.  But guess what?low estradiol combined with excess T3 can lead to high blood pressure, heart arrhythmia and sudden death.  Yikes! Obviously your hormones can pack a powerful punch so it is best to consider them all and get the complete picture before popping pills.

Interestingly, ovarian hormones are also very important to metabolism and their ratio may determine if and where we gain weight.  Most women blame estrogen for their midsection weight gain.  But that may not be the actual problem.  It may really be an issue of balance between estrogen and progesterone.  See as we age, we lose our metabolically active estrogen known as 17 beta estradiol.  17 beta estradiol is essential to improving our insulin sensitivity, improving our mood, increasing our energy levels, improving our clarity of thinking and memory, keeping blood pressure levels normal, maintaining bone density and improving our metabolic rate.  Obviously low levels or declining levels of 17 beta estradiol would have a negative effect on our metabolism and make us feel more sluggish.  When levels are low our weight gain shifts to our midsection.  Add to that the impact of high progesterone in relation to lower 17 beta estradiol and you have a recipe for misery.  See, progesterone is quite simply your pregnancy and fat building hormone.  It prepares a woman for nurturing a pregnancy.  It helps us to pull maximum nutrients and calories from our foods by slowing down our intestinal tract resulting in the bloated feeling we experience at the end of our cycle.  You know the feeling.  The feeling of being fat even if you are not but you are convinced that you are and you complain about to everyone that will listen.  They look at you like you are nuts but it is a very real sensation to you at that moment.  Now factor in that progesterone also decreases insulin sensitivity so we experience cravings for sweets and increased hunger.  So we feel fat but we keep eating anyway despite truly wanting to remain in control.  But at that moment, progesterone is the alien invader driving the mother ship, not you so weigh gain is inevitable without some serious willpower or careful consideration of your eating plan.  Unlike progesterone, estradiol can actually improve insulin sensitivity and reduces our sweet cravings.  That explains why we feel much more in control immediately following our period and why weight loss seems so much easier then.  At that point, estradiol is our co-pilot to paradise and everything seems right with the world again.  The sad truth is that those wonderful feelings will only last a short while before the alien invader returns to steer you off course again.

Now let's add a little more insult to injury so to speak.  17 beta estradiol also has a dramatic effect on our serotonin levels.  When it declines or if progesterone levels are too high in relation to it then are serotonin levels decline.  The result is greater risk for irritability, anxiety, obsessive/compulsive thoughts, eating disorders and decreased sleep.  Sound familiar?  Yep.  Sounds like the last couple weeks of your menstrual cycle doesn't it?  I thought so.  Any wonder why so many men avoid some women like the plague when the women are in the full throws of PMS!  We appear to freaking nut cases with the potential to inflict physical harm on unsuspecting victims without provocation.  And you know what?  I bet some of you have even thought about it at times.  So what do doctors on auto-pilot do to fix this problem? Well, they prescribe antidepressants of course!  It's very simple and in my opinion lazy to write out a quickie prescription for Prozac or some other SSRI without even doing a single test to see if that is the best approach.  But antidepressants are today's version of the Valium doctors used to prescribe for our mothers.  Sure--pop a little pill for a mood change.  Simple.  But it is a band-aid approach.  Wouldn't it be far better to get to the root of the serotonin decline and fix that instead?  Finally, progesterone delivers another sucker punch if you have too much of it.  Progesterone is your sedating hormone, which is great if you have trouble sleeping but in higher levels it causes fatigue and less desire to exercise.

So, let's add up the effects if you are progesterone dominant:  you feel fat, you have intense hunger and cravings so you eat anyway, you are hell to get along with and now you want to stay in bed all day.  Is there any wonder that weight control can be difficult?  Now aside from weight control, knowing what you know now, do you think progesterone creams make sense for women suffering with PMS?  I'm going to let you in on a little secret.  There are many creams available at health food stores that boost progesterone levels and are marketed as creams to help with PMS.  Women are slathering them on completely unaware that they may be making their symptoms worse with each application.  Also, a lot of doctors prescribe pharmaceutical grade progesterone cream for PMS so patients are doing the same thing under the direction of their physician!  How do I know?  Progesterone was prescribed for me and I applied it religiously daily for several days a month not once but two times a day!  My experience:  I felt fabulous the first 13 days of my cycle when my progesterone levels were lower and I was off the cream.  From days 14-25 (the days I used the progesterone cream) I was miserable.  I experienced intense cravings for sweets and processed carbohydrates, I was hungry all of the time, I was very sleepy and my gut felt like it did when I was pregnant.  Then, almost as if by magic, I was better as soon as I was off the cream.  After 3 months of that nightmare, I had an epiphany.  I remembered experiencing the exact same symptoms on Loestrin?a high progestin birth control pill.  I put the pieces together and made the connection between progesterone and my monthly symptoms.  At this point, I feel that it is necessary to remind you that progesterone replacement therapy is helpful if testing proves that levels are low.  Remember it is all about balance.  But if you are on Loestrin, Mircette, Alesse or some other high progestin pill and if you are also experiencing symptoms like mine then talk to your doctor about trying a lower progestin pill.  I promise it is worth the effort to test different pills.  After my experience with progesterone cream/progestins, I am convinced that the second half of the menstrual cycle can be a very difficult time especially if you are trying to lean down.  The cravings can be so intense that the urges override all rational thought.  We all know that we shouldn't be eating junk but we do it anyway.  Hence the reason we feel as if an alien has taken over our body. 

Now that we know what may be causing our problems what do we do about it?  I would suggest having a complete female hormone panel test done and monitor your symptoms for trends that can be predicted along with the rises and falls of your hormone levels.  You want to know exactly what your hormone levels are when you experience symptoms so your doctor can work to balance them.  There are also certain lifestyle changes and supplements that can help.  First and foremost, follow a balanced diet of smaller more frequent meals and exercise daily to boost your metabolic rate.  Supplements that may be of value include:

A good quality multivitamin?even the best diet can't give you all of the nutrients that you need due to the nutrient depletion of our soil.

B-complex?crucial for carbohydrate metabolism and the B vitamins are co-factors in the brain pathways to make serotonin and other mood regulating neurotransmitters.

Magnesium?in the brain it helps produce mood regulating chemical messengers that can regulate appetite.  Also associated with regulating blood pressure, critical for metabolic pathways, bone growth and muscle contraction.  Also a natural laxative which may help with the bloated feeling from a sluggish intestinal tract.

Calcium?maintains bones, helps with sleep, aids in normal muscle function.

Vitamin D?helps with absorption of calcium.

Essential Fatty Acids?fatty acids are the building blocks the body uses to make healthy fats.  Essential fatty acids such as Omega 3 and Omega 6 are the ones your body cannot produce on its own. They have an anti-inflammatory effect and can improve hair, skin, nails and gut motility.  They also assist in the production of the good cholesterol that acts as the building block for hormones as well as helping maintain normal brain function.