Hormonal Imbalances in Women

Understanding Hormones
The uterus is a pear-shaped organ which, in its non-pregnant state, is collapsed and about the size of your fist. The lower third of the uterus is called the cervix. The cervix has an opening called the os which opens into the vaginal canal and permits your period to flow out. Extending from each side of the uterus are the fallopian tubes. Near the end of each fallopian tube is an ovary. The ovaries are almond-sized organs which produce eggs. Each ovary contains from 200,000 to 400,000 follicles. These follicles contain the material necessary to produce eggs. The menstrual cycle is divided into two phases – the follicular or proliferative phase; and the luteal or ovulatory phase. This phase is followed by the premenstrual phase, known as the luteal phase. The inner lining of the uterus is called the endometrium. The endometrium sheds during menstruation.

The area of the brain called the hypothalamus, together with the pituitary gland, control the hormones necessary for reproductive health.
There are 6 hormones that serve as chemical messengers to your reproductive system:

• Gonadotropin-releasing hormone (GnRH)
• Follicle-stimulating hormone (FSH)
• Luteinizing hormone (LH)
• Estrogen
• Progesterone
• Testosterone

During your menstrual cycle, GnRH is released first by the hypothalamus. This causes a chemical reaction in the pituitary gland and stimulates the production of FSH and LH. Estrogen, progesterone, and testosterone are produced by the ovaries in reaction to stimulation by FSH and LH. When these hormones work in unison, normal menstrual cycles occur. When there is an imbalance of these hormones various problems can occur.
The most common hormonal imbalances faced by women are Premenstrual Syndrome, Menopause and PCO.

Premenstrual Syndrome
Premenstrual syndrome or PMS is the name given to a collection of physical and emotional symptoms that can occur in the two weeks before you have your period. These symptoms usually get better once your period starts and often disappear by the end of your period. Nearly all women have some premenstrual symptoms. Each woman’s symptoms are different but the most common symptoms include:

• mood swings
• feeling depressed, irritable or bad-tempered
• feeling upset, anxious or emotional
• tiredness or trouble sleeping
• headaches
• changes in appetite and food cravings
• feeling clumsy, possibly leading to increased accidents
• fluid retention and feeling bloated
• changes to skin or hair
• sore or tender breasts.

The levels of the female sex hormones estrogen and progesterone vary naturally during a woman’s menstrual cycle (the time from the first day of your period to the day before your next period starts). The symptoms of PMS are likely to be related to the cyclical fluctuation of these hormones. Women who use some methods of hormonal contraception are less affected by PMS. Research has shown that the likelihood of PMS is increased in women who are obese – a body mass index (BMI) over 30 – and in women who do little exercise.

In the first instance you can take some positive steps to try and improve your symptoms by:
• taking more exercise
• Eating a healthy balanced diet – decrease sugar, salt, caffeine and alcohol and increase fruit and vegetables.
There are a number of medicines for PMS which your doctor can discuss with you.

Menopause
The menopause is your last menstrual period. However, most women think of the menopause as the time of life leading up to, and after, their last period. In reality, your periods don't just stop. First, they tend to become less frequent. It can take several years for a woman to go through the menopause completely. Women are said to have gone through the menopause (be postmenopausal) when they have not had a period at all for one year. As you approach the menopause, your ovaries make less of two important hormones: oestrogen and progesterone. In the years before you reach the menopause, you may notice that your periods aren't so regular. This is often one of the first signs that your hormone levels are changing. It usually begins in your 40s and it can last for several years. Eventually, your ovaries make so little oestrogen and progesterone that your menstrual cycle and your periods stop. This is when you have reached the menopause.
These are common symptoms of the menopause:

• Hot flushes, where you suddenly feel hot and may go red in the face.
• Night sweats, usually caused by hot flushes at night.
• The lining of your vagina becomes drier and thinner during the menopause. This can cause itching and make sex painful.
• Losing interest in sex.
• Problems sleeping. You might find it hard to get to sleep, wake up because of hot flushes, or wake up very early and be unable to get back to sleep.
• Putting on weight and other changes such as a loss of muscle tone and increased fat around your middle.
• Feeling low or depressed or having mood swings. These negative feelings can include being irritable, anxious, panicky, and forgetful.
Many women do not have symptoms severe enough to require treatment. You can help yourself by the following measures:
• Eating a balanced, healthy diet with plenty of fruit and vegetables and low amounts of fat, including plenty of calcium (found in low-fat dairy products)
• If drinking alcohol, do it in moderation
• Maintaining a healthy weight
• Not smoking
• Doing regular exercise, including weight-bearing exercise like walking or jogging.

What is hormone replacement therapy?
All types of HRT contain an oestrogen hormone. If you take HRT it replaces the oestrogen that your ovaries no longer make after the menopause.
HRT is available as tablets, skin-patches, gels, nasal spray or implants (which are put under the skin). There are several brands for each of these types of HRT. All deliver a set dose of oestrogen into your bloodstream.

However, if you just take oestrogen then the lining of your uterus (womb) builds up. This increases your risk of developing cancer of the uterus. Therefore, the oestrogen in HRT is usually combined with a progestogen hormone. The risk of cancer of your uterus is very much reduced by adding in the progestogen. In many HRT products, the oestrogen and progestogen are combined in the same tablet, patch, implant, etc but they can also be taken separately. If you have had a hysterectomy, you do not need a progestogen.
An option to ease symptoms just in the vaginal area is to use a cream, pessary, or vaginal ring that contains oestrogen.

PCO
Polycystic ovary syndrome (PCOS) is a condition where the balance of hormones that you make in the ovaries is altered. In particular, your ovaries make more testosterone (male hormone) than normal. You do not ovulate each month. Some women do not ovulate at all. In PCOS, although the ovaries usually have many follicles, they do not develop fully and so ovulation often does not occur. If you do not ovulate then you do not have a period.

Symptoms that occur if you do not ovulate
• Period problems You may have irregular or light periods, or no periods at all.
• Fertility problems - you need to ovulate to become pregnant. You may not ovulate each month, and some women with PCOS do not ovulate at all. PCOS is one of the most common causes of infertility.
• Symptoms that can occur if you make too much testosterone (male hormone).
• Excess unwanted hair growth occurs in more than half of women with PCOS. It is mainly on the face, lower abdomen, and chest. This is the only symptom in some cases.
• Acne may persist beyond the normal teenage years.
• Thinning of scalp hair (similar to male pattern baldness) occurs in some cases .

Other symptoms
• Weight gain - about 4 in 10 women with PCOS become overweight or obese.
• Depression or poor self-esteem may develop as a result of the other symptoms.

If you have PCOS, over time you have an increased risk of developing type 2 diabetes, diabetes in pregnancy, a high cholesterol level, and possibly high blood pressure.

If you have no periods, or very infrequent periods, you may have a higher than average risk of developing cancer of the uterus (womb).
Tests may be advised to clarify the diagnosis, and to rule out other hormone conditions.

• Blood tests may be taken to measure certain hormones. For example, a test to measure testosterone and LH which tend to be high in women with PCOS.
• An ultrasound scan of the ovaries may be advised. An ultrasound scan is a painless test that uses sound waves to create images of structures in the body. The scan can detect the typical appearance of PCOS with the many follicles (small cysts) in slightly enlarged ovaries.

What is the treatment for polycystic ovary syndrome?
1. You should aim to lose weight if you are overweight. Losing weight can be difficult. A combination of eating less and exercising more is best. Advice from a dietician, may increase your chance of losing weight. Even a moderate amount of weight loss can help improves the chance of your ovulating, which improves any period problems, fertility, and may also help to reduce hair growth and acne. The increased risk of long-term problems such as diabetes, high blood pressure, etc, are also reduced with weight loss.

2. Unwanted hair can be removed by shaving, waxing, hair-removing creams, electrolysis, and laser treatments. Drugs taken by mouth can also treat unwanted hair growth

3. Some women have no periods, or infrequent periods. your risk of developing cancer of the uterus (womb) may be increased if you have no periods for a long time. Regular periods will prevent this possible increased risk to the uterus.Therefore, some women with PCOS are advised to take the contraceptive pill as it causes regular withdrawal bleeds similar to periods. If this is not suitable, another option is to take progestogen hormone for several days every month which will cause a monthly bleed like a period.

4. If you do not ovulate but want to become pregnant, then fertility treatments may be recommended by a specialist and have a good chance of success. But remember, you are much less likely to become pregnant if you are obese. If you are obese or overweight then losing weight is advised in addition to other fertility treatments.