Hormones are the chemical messengers of the body, and the endocrine system is the network that sends these messages. The glands that make up the endocrine system -like the brain, pancreas, gut, thyroid, ovaries, and others- produce hormones that regulate almost everything, from your mood, appetite, and energy levels, to your reproductive cycle and immune system.
The endocrine system and its interactions with other systems are highly complex. Since hormones usually have a wide range of functions and effects on the body, it’s easy to blame them for almost everything when you feel “off.” Unfortunately, in our current profit driven healthcare system, there are many companies across the country that are creating a great business for themselves by falsely creating unfounded fear that every woman's woe is related to her “hormones.” In my opinion, this is a failure of our system and leading to unnecessary fear, testing and treatments. I am writing this article today to help debunk some myths and educate women on the true facts about their hormones.
Checking a woman’s hormones is not as easy as it sounds. First off, there is a large variability of what is considered normal, from one woman to the next. Some factors that play a role are the time of day they are checked, the stage of her menstrual period, her current level of stress, and her baseline level. Secondly, the value in the blood is not telling us how that hormone is actually interacting with the receptor in which it has to bind to have an effect. This is why checking hormone metabolites in the urine has become so en vogue recently but it is expensive. And that leads to the third issue, often times insurance companies will not want to pay for these hormones and the patient ends up getting a large bill from her insurance company for these “uncovered” labs. They often deny to pay for the labs because they deem them “medically unnecessary.”
The way for a physician to know if your hormones are in balance is based on getting a full personal medical history, family history, a full assessment of all your symptoms, questioning about the regularity and heaviness of your periods, and a full physical exam. Once these questions and exam have been completed, your doctor should then have the information to come up with a diagnosis at that time, or know what labs and/or imaging studies are necessary to confirm the diagnosis. While checking labs, it is important to know that some vitamins and other essential nutrients should also be checked at that time because they are involved with how effectively your body interacts with your hormones.
Myth 1: “Hormone imbalances are the most common cause for feeling depressed, tired, and for gaining weight.”
Fact: Although hormones have an impact on mood and energy levels, hormonal imbalances are not a common cause of these symptoms. Instead, they are an underlying symptom of the real root cause. Sleep disorders, depression, and excessive psychosocial stress are the most common causes of chronic fatigue. Depression makes up 18.5% of chronic fatigue. The most common causes of weight gain are related to one's lifestyle including eating an unhealthy diet, lack of exercise, high stress, and poor sleep.
An unhealthy diet, lack of exercise, and high stress can also affect your hormone levels causing fatigue, depression, anxiety, weight gain, change in your periods, poor concentration, change in your appetite, poor sleep, and many other symptoms. This does not mean you have a problem with your hormones as this is not getting to the root cause. The hormone changes are a reaction to something else, not the cause. Unfortunately, there are a lot of quacks across the country that don’t get to the root of the problem but rather try to control your hormones with hormone pills, injections, and beads that are only band-aids but not a healthy long term solution.
To help make this point more clear, I’d like to give you an example: When you are facing a stressful situation, your cortisol levels can go up by 9 times their normal. This is a normal response to a stressful situation but doesn’t mean there is a problem with their cortisol hormone. The high cortisol can then lead to other hormone imbalances but the root cause is stress and that is what should be addressed, not treatment with more “hormones.” Getting to the root cause of a women’s hormone imbalances is often not done as there is more money in the treatment than the cure.
Myth 2: “Hormonal imbalances are because you have problems in the glands that produce your hormones”
Fact: No! The most common causes of hormonal imbalances are due to your lifestyle and how you manage stress. Disorders with your endocrine glands, the glands that produce your hormones, only represent 5% of the hormonal imbalances. Below we will discuss the most common endocrine causes of hormonal imbalances:
Perimenopause: When estrogen levels start to decline, women can face hot flashes, night sweats and anxiety. However, estrogen levels are not necessarily linked to the intensity of symptoms. Women can still suffer from severe symptoms even with “normal” estrogen levels; it just may not be “normal” for her. That is why it is essential, in my professional medical opinion, to have a baseline of your hormones when you are felling well and healthy so they can be used as your healthy baseline to compare to when you are feeling sick. Unfortunately, insurance companies usually will not pay for checking hormones when you are well. Insurance companies usually only pay for labs when you are sick and they can link each lab to a specific disease. To get labs when you are feeling well, you will likely have to either order online through a direct to consumer lab or through a Holistic, Preventative doctor who may have discounted lab prices, especially if you chose a Direct Primary Care doctor’s office like METSI Care.
Pre-diabetes: Obesity causing impaired fasting glucose and insulin resistance is the root cause of prediabetes. The more the weight gain, the larger the increase in insulin levels due to increased insulin resistance. This leads to an increase in blood sugars leading to Type 2 Diabetes. So in summary, insulin is a hormone that can be imbalanced but the root is the weight gain, not the insulin hormone.
Thyroid Goiter: A thyroid goiter is a condition where your thyroid gland is visibly enlarged. A goiter can occur regardless of whether your thyroid hormones are normal (euthyroid), are overactive (hyperthyroid), or underactive (hypothyroid). It can cause the entire thyroid gland to enlarge or develop lumps called thyroid nodules. The root cause of the goiter is usually not the thyroid hormone levels, but actually your iodine levels. Goiter is present in 5% of the American population.
Myth 3: I have a decreased sex drive because of my “hormones.”
Fact: One of the most common reasons woman want to get their hormones checked is because of having a decreased sex drive (libido). Other common causes are a change in periods, problems getting pregnant, and feeling fatigued. Unfortunately, the most common cause of a decreased sex drive are not related to your hormones. The root cause of decreased libido is usually due to physical or psychological causes. There have been multiple surveys to show that the health of your sexual relationship is more important than your sex related hormones determinants of sexual function for midlife females. Depression, stress and anxiety are also common causes of reduced sex drive, and treatment for some of these conditions (especially depression) can also decrease libido.
Physiological causes for reduced sex drive are not as common, but they are responsible in the cases of perimenopause or menopause, hormonal contraception (in some cases), endometriosis, or with some antipsychotic medications.
There’s no “normal” amount of sex drive, as it varies from person to person, but what’s important for most is having a healthy sex drive. When dealing with a reduction in your sex drive, it is important to open up and discuss with your partner, doctor or therapist, to help figure out the root cause and come up with a plan, usually through lifestyle change, to help. Exercise, healthy eating, reducing stress, and reducing alcohol/drugs can all help improve libido and should be considered before initiating hormone therapy. Also vitamins and nutrient levels should be checked as they can interfere with your sex drive hormones. Communicating your feelings with your partner or seeing a therapist may be some of the best ways to get your sex drive back on track.
Myth 4: “Adrenal fatigue is due to a problem with my hormones.”
Fact: The term “adrenal fatigue” has been used in non-scientific groups to explain a hallmark of symptoms that occur in people who are dealing with mental, emotional, and/or physical stress. The idea of “adrenal fatigue” is that during periods of prolonged stress, the adrenal glands that produce both cortisol and adrenaline (epinephrine) start to decrease production of those hormones via a process called negative feedback inhibition, with the resulting symptom of fatigue.
“Adrenal fatigue” can occur when someone has been undergoing long-term treatment with steroids, where the external cortisol-like drug signals the brain to decrease production as it believes that there’s enough adrenal hormones already circulating in the body. If the external source of steroids is removed abruptly, the adrenal gland cannot keep up with the hormone production, triggering adrenal insufficiency.
True adrenal insufficiency is very rare, and often associated with immunotherapy, or serious conditions like Addison’s disease, cancer, infections or untreated autoimmune diseases. There is no scientific evidence of the existence of adrenal fatigue, and the general scientific consensus is that “adrenal fatigue” is a stress-related response leading to a changes in brain chemistry, causing the fatigue or mood related symptoms.
Myth 5: “My hormone imbalance needs to be treated with medication”
Fact: In the majority of cases, medication is not necessary to achieve hormonal balance. Following a healthy diet, regular exercise, practicing stress relieving activities and maintaining a healthy weight are keys to maintaining a healthy hormone profile. Avoiding phytoestrogens and excess sugar, and processed or inflammatory foods can help improve your symptoms related to your hormonal imbalance, including your weight, mental health, menstrual cycle and sex drive.
An important part of having a healthy balance of hormones is related to your nutrition including fats. Not all fats are bad. Eating a diet with healthy plant based fats like olive, sunflower, coconut and avocado oils, nuts, seeds, avocado and fish can help your body in its production hormones to keep your body in balance.
Hormone replacement therapy (HRT) has emerged in the past two decades as an option for women in perimenopause or menopause. It not only helps with the reduction or prevention of menopausal symptoms, but also protects against osteoporosis and heart disease. However, it is very important to note that HRT may increase the risk of breast cancer, ovarian cancer, and uterine cancer in certain situations, especially if there is already a family history of such cancers.
Hormones are complex, and they are very much interconnected where when one hormone is off, it can negatively affect the other hormones. Getting to the root cause of your hormone imbalance of tantamount in helping restore a normal hormone balance without the risk of negative side effects or an increase in the risk of cancer. It’s always important to consult your doctor to discuss your hormone concerns to help get you back on track. Many times this can be achieved without expensive tests or medications.
At METSI Care, we practice a science-based holistic approach to women’s health that aims to get to the root cause, without making you spend lots of money on things that likely won’t help you long-term. We are able to do this because we give you the time to share with us all your concerns, review your personal medical and family history, and provide you with a personalized plan to help you feel like you again!
If you are interested in our holistic, integrative approach to health, please call us at 512-729-5575 to learn more or set up a free Meet & Greet with Dr. Garrick. We are accepting new patients, and welcome you to join the METSI Care family!