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FREQUENTLY ASKED QUESTIONS ABOUT HORMONES

What are hormones?
What are the main hormones in women?
How do I tell if my cycle is normal?
Are irregular periods just an inconvenience or can they be harmful?
Why do hormones cause so many problems?
What are the main problems caused by each hormone?
Why do my hormones give me such a hard time but my best friend
     breezes through each cycle and hardly notices?

Are hormone problems difficult to treat?
Is there hope for hormone problems?
In your experience, what are the most distressing hormone problems?
I’ve been told my alopecia (hair loss) is untreatable. Is this true?
What about hormones and female acne? Mine is usually worst before my period – when I feel
    worse too.

I have not only acne but also increased hair on my face combined with thinning scalp hair.
    How can life be so unfair as to give me all of these problems at once?

I went to my doctor with what I thought was a hormone problem but was told
    that all my tests were normal and so nothing could be done. How can this be?

Are treatments for hormone problems safe?
Do I have to take prescription medications or are there effective alternative treatments?
Do men have hormone problems too?
How do I find a doctor who can help my hormone problems?
What other resources are available?
 

What are hormones?
Hormones are chemicals in the blood which serve as messengers to coordinate body functions. For example, thyroid hormone regulates the overall rate of metabolism throughout the body. Cortisol (often referred as “cortisone” which is a related hormone) orchestrates the body’s response to stress and has other functions as well. Many hormones do their work unobtrusively so you never even notice them. Usually hormones attract notice only when they are acting up.

What are the main hormones in women?
Women have all same hormones that men do but the levels of some are different. Estrogen is the main female hormone. It brings about the widespread bodily changes of puberty and, together with progesterone, produces the menstrual cycle. With the approach of menopause, estrogen levels wane producing yet another set of changes in body and brain. Progesterone helps prepare the uterus for pregnancy or menstruation and protects it against excessive effects of estrogen. Its effect on mood is complicated. It can soothe or agitate. You were probably told that Testosterone is the male hormone and it is. But it is also an important hormone for women. It helps maintain the strength of the bones and plays some role in sex drive. Though women’s levels are only about a tenth the level of men’s, even these small amounts can cause unwanted effects such as acne, increased facial and body hair and scalp hair loss.

How do I tell if my cycle is normal?
Women’s bodies are not machines. Almost nobody has periods which are always exactly 28 days apart. A few days variation is usual and should not cause worry. In general, a cycle is normal if periods are at least 3 ˝ weeks and no more than 5 ˝ weeks apart. Some variation greater than this can be normal but should be checked out. Irregular periods can be a sign of a significant medical condition.

Are irregular periods just an inconvenience or can they be harmful?
Irregular periods in themselves will not harm your body. However an abnormal cycle can be a sign of an underlying hormone problem. Many conditions can show themselves as irregular periods. There may be too little estrogen which is bad for bones. Or there may be high levels of estrogen and a lack of progesterone which can be bad for the uterus. Workup and treatment are necessary if a woman’ cycle is truly abnormal. Many women are told that told that irregular periods don’t matter unless you are trying to get pregnant. This is not necessarily true and, anyway, you will want to know why they are irregular. If you are not getting clear answers, you may want to consider a consultation with a specialist in female hormone problems.

Why do hormones cause so many problems?
First of all, they prevent more problems than they solve. Female hormones enable the body to become adult at puberty and make it possible to continue the human species. They probably play some role in forming personality and they give women a longer lifespan than men. Because hormones have so many different effects, they may have positive effects on one part of your body and negative effects on another. Also hormone levels fluctuate and the resulting instability of body chemistry can be uncomfortable.

What are the main problems caused by each hormone?
Estrogen
in high levels can cause nausea and breast discomfort. Low levels result in the well known symptoms of menopause: hot flashes, night sweats and insomnia, low mood, vaginal dryness, skin discomfort and others. Large fluctuations in estrogen are common and can cause mood swings and a general sense of ill being.

Progesterone has a complex effect on mood. It calms some women and agitates others. Some synthetic forms can cause mood changes.

Testosterone helps bones and sex drive but it is also the cause of female acne, increased facial and body hair and most female hair loss.

Why do my hormones give me such a hard time but my best friend
breezes through each cycle and hardly notices?

We are learning that some women are hormonally vulnerable. They may have wider shifts in hormone levels, or their bodies may be more delicately balanced so that they feel the shifts more acutely. The most important thing, if you are hormonally vulnerable, is having your sensitivity recognized so that you can be helped.

Are hormone problems difficult to treat?
They need not be. However hormones are complex and highly individual. Proper treatment requires a detailed medical history and examination be done first together with specialized lab testing so that subtle abnormalities can be detected and an individualized treatment plan developed for you.

Is there hope for hormone problems?
Yes. Recent decades have seen enormous increases in knowledge about hormones which can be applied to helping hormonally vulnerable women. Since this is new and specialized, not all doctors are familiar with it.

In your experience, what are the most distressing hormone problems?
It is hard to pick just one but I would probably say alopecia (hair loss). Hair loss is normal for men (though we don’t like it) but not for women. It can take a tremendous toll on self-esteem. Alopecia is even more frustrating because most women with the common hormonal form, androgenic alopecia, are told that it is untreatable. This is untrue. There are several treatments which have a good chance of working. Very few doctors are knowledgeable about female alopecia but do not give up hope. There are some out there who do understand it.

I’ve been told my alopecia (hair loss) is untreatable. Is this true?
Probably not. While there are many causes of female hair loss, the most common is so-called androgenic alopecia. The thinning is mainly on the temples and top of the head. (If hair is lost completely on certain areas, this is alopecia areata, a quite different condition.) Androgenic alopecia happens because testosterone shrinks the hair follicles. Medications which lower or block testosterone can help a lot.

What about hormones and female acne?
Mine is usually worst before my period – when I feel worse too.

Acne is also caused by testosterone which stimulates the oil glands. Too much oil in the skin is the first step in the chain of events leading to break-outs. As with alopecia, medications are available to lower or block testosterone and these can usually clear even the most resistant acne. Birth control pills like OrthoTriCyclen probably help acne by lowering testosterone. But there are other medications which can help further.

I have not only acne but also increased hair on my face combined with thinning scalp hair.
       How can life be so unfair as to give me all of these problems at once?

There are definitely times when hormones don’t play fair. Like acne and alopecia, increased facial and body hair is caused by testosterone. When two or three of these go together, there may be an underlying condition called polycystic ovary syndrome (PCOS).  Testosterone levels can be slightly elevated– although still much lower than those in men. There are also changes in metabolism caused by high insulin levels. PCOS is discussed in detail elsewhere on this website.

Can you give some other examples of common women’s hormone problems which can be helped?
As I have said, acne, increased hair growth and hair loss are highly treatable. PMS – both the physical and mental aspects – can almost always be helped. With mild PMS, occasional use of an herb or supplement may be all that is needed. Other women, whose cycles are more troublesome, will be best helped by a comprehensive holistic program.

For women having a hard time with menopause, there are many helpful treatments; HRT is not the only one. Even HRT can be adapted to the needs of the individual woman. Other problems which can often be helped include irregular periods, mood swings and loss of energy, loss of sexual desire and others. But it may take some effort to find a doctor who has the right knowledge base to help.

I went to my doctor with what I thought was a hormone problem but was told
that all my tests were normal and so nothing could be done. How can this be?

Hormones can cause problems without tests being abnormal. There can be several reasons for this: 1) The level may be abnormal but only sometimes and the blood may have been drawn at the wrong time to catch the abnormality – hormones can be sneaky! 2) Levels are normal but your body is abnormally sensitive to your hormones – this is hormonal vulnerability. 3) Levels are normal but have wide swings – a single blood test cannot detect excessive fluctuations.

Are treatments for hormone problems safe?
In general, treatments are safe but side effects are possible with any medical treatment and none should be undertaken casually. As with any medication,, you should have a complete explanation of what the treatment options are and possible side effects with each. Usually some monitoring is necessary. This means regular follow-up visits to review your situation and sometimes regular lab tests.

Do I have to take prescription medications or are there effective alternative treatments?
Some hormonal conditions, PMS for example, can often be treated effectively by herbs and supplements. For others, such as increased facial and body hair, no herbs have been found which make much difference. Also, response is very individual, especially with alternative treatments. It often makes sense to consider alternative treatments before deciding to go to prescription medications. However don’t rule out medication; some can be dramatically helpful.

Do men have hormone problems too?
Yes we do. There are two differences however. In men, the reproductive system is much simpler and hormone levels are fairly constant because all they need to do is stimulate development of sperm. In women, the monthly production of an egg cell requires a complex pattern of hormonal shifts which can be uncomfortable at times.

The other difference is in the age at which problems occur. When men get hormone problems, it is usually in their fifties or later but for women, they can begin even in the teens.

How do I find a doctor who can help my hormone problems?
Endocrinology is the medical specialty concerned with hormones. Specialists with advanced training in this field are referred to as endocrinologists. They have received initial training in pediatrics, internal medicine or gynecology. Many endocrinologists subspecialize and so if you are considering consulting one, it is best to call and find out if his or her expertise is in the area in which you have having difficulty.

Even though female hormone problems are extremely common, few endocrinologists focus their practice in this area. Reproductive endocrinologists, originally trained in gynecology, tend to concentrate on infertility rather than the common problems women have when they are not trying to get pregnant. Like patients, physicians are individual so it is best when you can some ideas in advance of that doctor’s philosophy and approach.

What other resources are available?
There are a variety of organizations which help women with hormone problems, most of which have websites. Many are listed in the Links section. Keep in mind however that the quality and accuracy of medical information on the web varies greatly. You need to exercise some caution in interpreting it. Often people who post are those who are most frustrated, so they can sound discouraging. Don’t let yourself give up hope however because hormone problems can almost always be helped.

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