Premenstrual Syndrome (PMS)
Women who don't have premenstrual syndrome or only have it
mildly cannot conceive how seriously
it can affect the health and happiness of some
women, their families, and society at large.
Premenstrual syndrome is a clustering of symptoms,
both physical and emotional, occurring
between ovulation and menstruation. PMS may
be of short duration (2 to 3 days just prior to
menstruation) or it can last for three weeks out
of each cycle-from around ovulation (generally
mid-cycle)-until the end of the period.
Symptoms may range from mild to extremely
severe and will recur cyclically each month (occasionally
alternate months).
The symptoms in a classic case of PMS disappear
for at least a week in a 28-day cycle (characteristically
the week from the end of menstruation
until ovulation). Some months, the PMS may
be worse than others. Typical patterns include
pattern A, which occurs a week before the period;
pattern B which occurs 9 -10 days before
menstruation (at times there are some symptoms
at ovulation, then a break for several days);
and pattern C which occurs from ovulation on.
There are variations on these patterns, but when
the symptoms occur the week before ovulation,
some other factor has been added to PMS.
There are approximately 150 known symptoms
of PMS.
Nobody has them all, but women generally
say that the emotional problems are the
worst. Estimates suggest that 40 to 60 percent
of women experience some form of PMS. About
5 to 10 percent of menstruating women experience
serious, even life-threatening symptoms.
It is possible for some women to get PMS-like
symptoms when they don't ovulate, don't menstruate,
and even after a hysterectomy (with or
without ovaries).
Young girls may begin cyclical symptoms as
early as two years before puberty, causing them
to develop behavioral problems. PMS may last
till menopause, and, for a small proportion of
women, even beyond. Where a woman has severe
PMS, the whole family is affected. It is a
major cause of divorce and stress in relationships,
and linked with emotional and physical
child and husband abuse. It also has profound
ramifications on society, and is a factor in petty
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crime(such as shoplifting), increased serious crime
(physical violence), increased hospital,
prison, and psychiatric admission, and increased
rate of suicide attempts. It can also affect school
and work performance.
There seems to be a strong family history in women
with PMS. Onset is frequently at puberty.
Other women's PMS may begin or worsen after
being on the oral contraceptive pill or going off
it; after pregnancy, especially with toxemia; after
a tubal ligation; during or after a time of ab-sence
of menstruation (amenorrhea); and after
having a hysterectomy.
PMS can be associated with other conditions,such
as thyroid or adrenal dysfunction, postpar-tum
depression, menopause, endometriosis,
polycystic ovaries, and anorexia nervosa and
bulimia. These conditions may cause the PMS
pattern to be lengthened or less clearly defined.This
means treatment is varied, and it is obviously
important to try to work out the reason why
a particular woman is experiencing PMS.
Depending on the cause and severity of the
PMS, a wide range of treatments is available,
including nutritional, herbal, hormonal, and other
remedies. When the "alternative" approach fails
to bring adequate relief, nature may need the
nudge of temporary or long-term hormonal
help-estrogen, natural progesterone (sometimes
alone), and/or thyroid therapy.
Generally, treatment varies according to how
long a woman has had PMS, how complex her
history is, and how long she experiences symptoms
during the cycle. Life-style changes are
appropriate fi>r all. Some women can deal with
their symptoms successfully just by using natural
remedies. Others will have no relief without
hormonal intervention and, sometimes, may require
the addition of an antidepressant. Some
Nomen \/.Iill only need short-term hormonal
herapy to obtain complete relief. Others need :continuing help
At the Center for Hormonal Health, we give you
multifaceted options based on observation, history-
taking, objective testing, and your preferences.
The good news is that even long-standing,
complex problems can be significantly
helped. Life can be great again. "*
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P R E M E N S T R U A L S Y N D ROM E
S Y M P TO M S |
| Acne |
| Addiction |
| Aggression |
| Agoraphobia (fear
of open spaces and crowds) |
| Anxiety attacks |
| Asthma |
| Boils |
|
| Bursitis |
| Conjunctivitis
(red eye) |
| Depression |
| Epilepsy |
| Fainting |
| Fatigue |
| Headaches |
| Herpes |
|
| Hives |
| Inappropriate
anger |
| Irritability |
| Migraines |
| Nausea |
| Neuralgia |
| Recurrent
infections |
| Sties |
|
| Suicidal
tendencies or attempts |
| Tonsillitis |
| Violence |
| Wanting to run |
| Weepiness |
| Withdrawal |
| Yeast |
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Early Estrogen Deficiency and Menopause
Because of the increase in life expectancy during
this century, menopause is a fact of life for
many more women than it used to be. Ideally,
menopause should not be a difficult transition.
Normally, the body is programmed to produce
low, but adequate, supplies of estrogen and other
necessary hormones after menstruation ceases.
In reality, however, only about 10 to 30 percent
of women make this natural transition with ease.
This may be because of the western diet with its
high-fat, high-protein content, and other life-style
and cultural factors.
Some women go through early menopause or
untimely hormonal decline because of premature
ovarian failure, caused by damage or autoimmune
disease, tubal sterilization, hysterectomy,
surgery on thQ ovaries or as a result of
medication (chemotherapy or radiation for cancer,
cortisone, etc.).
The average age women cease to menstruate
is around age 51, but women may experience
premenopausal changes to their menstrual cycle
from about age 43 onwards (some before age
40). Many women experience a wide range of
menopausal symptoms including (vague): insomnia,
depression, mood swings, irritability, or
(obvious): hot flashes, night sweats, drying of
the vagina and bladder tissues, problems urinating,
joint and muscle pain, lowered sex drive,
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or (hidden): brittling and loss of bone (osteoporosis),
and heart disease.
The length of time women experience symptoms
may be brief or long-term (some women experience
hot flashes for over 30 years). The impact
of these symptoms may be extremely severe.
Though conventional literature indicates that the
depression experienced around menopause is
only mild, some women have a severe degree
of depression around this time.
Wh!le some women abruptly stop their periods
at menopause, other women experience
changes in their bleeding over many years.
These changes include irregular periods, shorter
and longer cycles, mid-cycle spotting, heavy and
clotting periods, scanty periods, and absent periods.
Though these symptoms are all normal at
menopause, physicians like to do some type of
endometrial sampling (the lining of the uterus)
to rule out endometrial or cervical cancer. Uterine
cancer1s initially painless and can occur with
no bleeding, little bleeding, or heavy bleeding.
Having a baseline sampling of the uterus is a
safeguard against developing cancer.
Natural remedies and other life-style changes
may be very helpful in minimizing the obvious
symptoms of menopause (such as hot flashes),
but may mask the hidden effects of estrogen loss
such as osteoporosis and heart disease. Over
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50,000 women a year die from bone fractures
resulting from osteoporosis which causes the
rapid acceleration of bone loss in women after
menopause. Over 400,000 women die annually
of heart disease and strokes after menopause.
The western high-protein diet and smoking are
largely responsible for the high incidence of osteoporosis
among postmenopausal women in
the West. Women who eat animal products freely
in their youth, teens, and twenties experience
early bone loss. Whenever the intake of protein
exceeds 15 percent, the kidneys require large
amounts of fluid to rid the body of the excess
protein, and this inevitably triggers the loss of
minerals, including calcium, in the process.
Wherever there is poor diet, frequent dieting,
eating disorders such as bulimia and anorexia,
lack of calories or low estrogen levels (this can
happen even in the teens), there will probably
be bone loss. It is considered wise to have a
baseline bone density done at age 35. But some
women need it much earlier in life.
Osteoporosis is a major health problem in later
life, causing disability and even death. Most
women can benefit by finding out if they are losing
bone early. Prevention and even reversal is
possible. Early calcium deficiency and the subsequent
bone loss cannot be reversed by diet
or calcium supplements. But further bone loss
can be prevented by taking estrogen. The use
of natural progesterone with estrogen can stimulate
the regrowth of the bone matrix.
Some consider testosterone to be the best bone
builder, and women may need a little. Care
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should be taken, however, as it is very easy to
overdose. Sometimes, taking DHEA (dehydroepiandrosterone,
an adrenal androgen) in place
of testosterone can produce enough testosterone
as a by-product. It is wise, however, to
measure DHEA levels first.
It is important to balance estrogen before any of
the other sex hormones are added or they can
act as anti estrogens and make the symptoms
worse.
The issue of taking hormones at menopause is
a quality of life decision. Life may only be extended
a relatively short time, but most women
feel better if their hormones are balanced. While
some women do not need hormones after menopause,
a significant number of women will find
their symptoms continue to make them miserable
for years if they don't take them.
Women are often reluctant to take estrogen because
it has been linked with breast cancer and
uterine cancer. However, many leading researchers
consider the combination of estrogen,
progesterone, and testosterone protective
against uterine and postmenopausal breast cancer.
Doctors compare the fatality rate from heart disease,
strokes, and osteoporosis complications
(about 55 percent of women) with death from
breast, ovarian, and uterine cancer (about 7-8
percent), and find the evidence for wise use of
hormones compelling. At the Center for Hormonal
Health, we can help you with any problems
with menopause or premature estrogen
deficiency. "*
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P E R I M E N O P A U S E & M E N O P A
U S E |
| Anxiety |
| Bladder infections |
| Bleeding irregularities |
| Bloating |
| Bone loss |
| Brittle and grooved nails |
| Confusion |
| Constipation |
| Colitis |
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| Disinterest in life |
| Dizziness |
| Dry, wrinkling skin |
| Forgetfulness |
| Fractures |
| Gum disease |
| Heart palpitations |
| Heavy, clotting bleeding |
| Hot flashes (short) |
| Hot flushes (long) |
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| Inappropriate
emotional responses |
| Insomnia |
| Irritability |
| Itching or burning skin |
| Low frustration |
| Low self-esteem |
| Lowering of libido |
| Male pattern of body hair |
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| Mood
swings |
| Muscle weakness |
| Night sweats |
| Paranoia |
| Stomach pains |
| Suspicion |
| Thinning of hair |
| Vaginal dryness |
| Weight gain or loss |
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Thyroid Disorders
Many women with hormonal problems-premenstrual
syndrome, postpartum depression,
and early or difficult menopause-have a connected
thyroid condition. The thyroid is a butterfly-
shaped gland in the neck, and its influence is
felt universally in the body. Thyroid controls metabolic
rate. It affects temperature and circulation,
and it directly affects moods and emotions. It is
also linked with menstrual cycle balance.
Of these women with thyroid problems, by far
the majority will be low thyroid (hypothyroid).
Their metabolism and body functions will slow
down. Relatively fewer have high thyroid (hyperthyroid).
Their metabolism and body functions
speed up.
Women may have a lifelong thyroid problem,
often exacerbated by puberty. They remember
feeling unduly fatigued, depressed, and irritable
most of their lives. They often have recurrent
infections and allergies. Hypothyroid women often
experience a variety of problems with their
periods, including irregular or missing periods
caused by failure to ovulate properly, heavy
bleeding, painful periods, single or multiple ovarian
cysts, fibroids, reduced fertility, repeated miscarriages,
and toxemia in pregnancy.
Frequently, particular families have a strong history
of thyroid problems. In some cases, many
or all female members on the maternal side of
the family already take thyroid. Commonly, the
individual seeking help has been on thyroid at
some point in her life. Sometimes the woman's
physician has checked her thyroid repeatedly
because he or she is suspicious that there is
some dysfunction. Often, because the blood levels
are within range, the woman is declared normal,
and no treatment is given.
Women suffer from three to
five times as often from depression as do men, and women
have thyroid problems at least eight times more frequently
than men. Some researchers have linked
the two frequencies and believe that thyroid and
depression are linked.
A great deal of research by psychiatrists has
been done over the past 25 years (since 1969)
on the link between thyroid insufficiency and
depression. The research has also shown a
strong link between thyroid abnormalities and
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anxiety and panic disorders, anorexia nervosa,
rapid cycling (manic and bipolar disorders), paranoia,
psychosis, and other emotional disorders.
Myxedema (when the thyroid doesn't function)
madness, has been recognized since the late
1800s. Psychiatrists often use active thyroid to
augment treatment in depressed individuals who
do not respond to antidepressant medication
alone.
The ultrasensitive TSH test is considered the
gold standard of thyroid tests by most nationally-
recognized endocrinologists. (TSH is an
abbreviation for thyroid stimulating hormone
which is produced in the brain's pituitary gland.)
Endocrinologists are not comfortable treating
people with tests that are within range. But some
psychiatric research has shown that the thyroid
panel and TSH tests do not alway&: reveal marginal
or borderline thyroid problems. Some psychiatrists
also use the TRH stimulation test, measuring
the output ofTSH after an injection of synthetic
TRH (the hypothalamic releasing hormone).
This is controversial.
The thyroid panel and TSH also may not show
up early cases of thyroiditis. The most common
type-Hashimoto's thyroiditis-is named after
the Japanese man who discovered it. This is an
autoimmune condition and is the most common
cause of hypothyroidism in women. Some believe
that ingestion of too much iodine in the diet
leads to the formation of autoimmune antibodies
which begin to destroy thyroid function. One
in approximately 8 to 10 women have
Hashimoto's thyroiditis, and women experience
it up to 25 to 50 times more commonly than men,
according to Dr. Richard Bronson.
In some cases, this disease appears to be transitory
(e.g. after pregnancy). But often it leads
to permanent hypothyroidism. In the early stages
of this disease, women may fluctuate between
being euthyroid (normal), hypothyroid (low thyroid),
and hyperthyroid (high thyroid). In fact,
these fluctuations in thyroid function over months
and years are the hallmark of this disease. But
the end result over a period of years is hypothyroidism
from damage to the thyroid gland.
In the early stages, women may be quite symptomatic
with typical/symptoms of low or high
(or both) thyroid function. While the majority of
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board-certified endocrinologists would maintain
that treatment is not necessary if the TSH level
is normal, some individual endocrinologists
believe that it is wise to treat Hashimoto's early
to kill the antibodies and avoid permanent damage
to the thyroid.
Two things should be noted. First, thyroiditis is
often linked with other autoimmune diseases
such as lupus erythematosus, MS, rheumatoid
arthritis, Sj0gren's syndrome, and ovarian or
adrenal failure (there are many such thyroidautoimmune
connections). Where thyroiditis is
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suspected, other autoimmune problems may
need to be ruled out.
Sometimes the problem may look like a thyroid
problem, yet when all the tests are done, thyroid
function is normal, but estradiol levels are
very low. Estrogen deficiency can looked remarkably
like thyroid deficiency-loss of hair,
joint and muscle pain, depression, fatigue, feeling
the cold, dry skin and hair. It is important to
find out which hormone is the culprit. Sometimes
it is both, because the thyroid is intimately
connected with ovarian function. '*
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S Y M P T O M S O F H Y P O T H Y R O I
D S Y N D R O M E |
| Acne |
| Agitation |
| Allergies |
| Apathy |
| Asthma |
| Athlete's foot |
| Bladder disorders |
| Blurred vision |
| Boils |
| Brittle, splitting nails
(transverse ridges in thumb especially) |
| Chest pain |
| Coated tongue |
| Cold hands and feet |
| Colds |
| Colitis |
| Confusion |
| Constipation |
| Coughing
and |
| Dandruff |
| Dark circles under the eyes |
| Depression |
| Diabetes |
| Diarrhea |
| Dizziness |
| Drowsiness |
| Dry lips and skin |
| Eczema |
| Endometriosis |
| Excessive sleeping |
| Failure to ovulate |
| Fainting spells |
| Fatigue |
|
| Fibromyalgia |
| Fluid retention |
| Food allergies |
| Food cravings, weakness,
shaking |
| Forgetfulness |
| Frequent urination |
| Fungal infections |
| Gas |
| Generalized swelling-hands,
feet and ankles, around eyes, stomach |
| Hair loss |
| Hallucinations (rare) |
| Headache |
| Heavy menstrual bleeding |
| High cholesterol |
| Hives |
| Hoarseness |
| Hyperactivity |
| Inability to lose weight |
| Infertility |
| Insomnia |
| Irritability |
| Irritable bowel syndrome |
| Itching, burning eyes |
| Itchy ears |
| Itchy, stuffy, runny nose |
| Joint pains |
| Leaking breasts |
| Long cycles |
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| Low
basal temperature |
| Low blood pressure |
| Low blood sugar |
| Menstrual irregularities |
| Migraine |
| Missing periods |
| Mitral valve prolapse |
| Mood swings |
| Mouth ulcers |
| Muscle aches and pains |
| Muscle weakness |
| Nervousness |
| Nightmares |
| Nosebleeds |
| Numbness and tingling |
| Other vaginal infections |
| Painful periods |
| Palpitations |
| Panic and anxiety |
| Paranoia |
| Photosensitivity (sensitive to
light) |
| PMS |
| Poor concentration |
| Poor response to the pill |
| Post nasal drip |
| Postpartum depression |
| Premature menopause |
| Puffy eyes |
| Rage |
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| Rapid
or irregular pulse |
Recurrent bronchitis/
pneumonia/
infections |
| Red eyes |
| Respiratory infections |
| Ringing in the ears |
| Seizures |
| Sensitivity to noise |
| Shortness of breath |
| Short-term memory loss |
| Sinusitis |
| Slow pulse If |
| Sore throat |
| Sore, fibrocystic
breasts |
| Spaciness |
| Spontaneous bruising |
| Spots before the eyes |
| Suicidal thoughts |
| Swollen joints |
| Teary eyes |
| Thin, brittle, sparse hair |
| Toxemia in pregnancy |
| Trouble swallowing |
| Water retention |
| Yeast infections |
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Estrogen, progesterone, thyroid, and cortisol
imbalance have all been implicated in PPD, and different researchers have used
these individual hormones to help different
women. Dr. John Studd (U.K.), recommends
the use of estrogen for women with PPD. Dr.
Kq!harina Dalton (U.K.), has used natural
progesterone for many years to treat PPD.
Dr. James Alexander Hamilton (San Francisco),
has used thyroid to treat PPD that
develops about three weeks after delivery.
There is a fairly high incidence (11 percent)
of postpartum and Hashimoto's thyroiditis,
occurring after delivery due to autoimmune
reaction to the hormonal changes of pregnancy.
While this is usually transient and disappears,
about 30 to 40 percent of women
with these types of thyroiditis develop permanent
thyroid problems within 3 to 4 years.
Hamilton also mentions lone Railton, a San
Francisco physician (now deceased), who,
in two research projects successfully used
low doses of hydrocortisone to treat postpartum
depression (particularly the type occurring
about day 3 postpartum).
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Women with postpartum depression, anxiety,
and exhaustion have special needs that need
specialist care. PPO is an under-recognized,
often untreated disorder that needs prompt
care and attention. At the Center for Hormonal
Health, we offer expertise in handling
treatment for the hormonal side of PPO and
the support such women need. "*
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POSTPARTUM DEPRESSION |
| Alienation |
Guilt |
| Anger |
Headaches |
| Anxiety |
Insomnia |
| Apathy |
Irritability |
| Child Abuse |
Low Sex Drive |
| Crying |
Marital Conflict |
| Depression |
Murderous thoughts |
| Exhaustion |
Panic attacks |
| Fear |
Paranoia |
| Forgetfulness |
Suicidal Thoughts |
| Futility |
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