Hormones! From PMS to menopause, these messengers of womanhood can affect your mood, your weight, your food cravings - even your desire for sex. For many women, it's smooth sailing, but for others, it's a shipwreck at every turn of the hormonal bend.
"Women can be, and many are, greatly affected by hormone fluctuations. Sometimes it gets to the point of feeling totally overwhelmed - as if for a time they have lost control of their life," says Christiane Northrup, MD, author of The Wisdom of Menopause and Women's Bodies Women's Wisdom.Dieting, stress, anxiety, depression - even exercise -are all among the factors that can create a hormonal tailspin. So there are plenty of opportunities for things to go awry.
At the same time, Northrup tells WebMD, there are many opportunities to change the way you feel. "Sometimes, even the smallest changes can make a huge difference," she says.
Hormones: The reproductive years
"Medically speaking, anything that occurs right before your period - such as cramps, diarrhea, and breast tenderness - is considered pre-menstrual syndrome," says Steven R. Goldstein, MD, professor of obstetrics and gynecology at NYU Medical Center in New York City. But for most women it's the mood issues that become the defining factor for what we know as PMS." And, says Goldstein, this can include anything from mild to moderate depression, anxiety, mood swings, melancholia, sensitivity, even full-blown anger and self-hatred.
Indeed, Northrup says women who are premenstrual are apt to perceive comments made about them as negative, even when they are not.
Experts say that mood swings and other symptoms do not necessarily indicate abnormal hormone levels. "Every study done on women with PMS shows their circulating levels of hormones are normal," says Nanette Santoro, MD. Santoro is director of the Division of Reproductive Endocrinology at Montefiore Medical Center and the Albert Einstein College of Medicine in New York City. "But some researchers believe that certain hormone metabolites in the brain cause the mood changes - or that some women just metabolize hormones differently. No one knows for sure."
But while doctors may not know what is causing your symptoms, there are ways to control them. "You can't change your physiology," says Northup. "But you can change your life. Very often when you do, your hormones respond in a favorable way."
PMS: What you can do
One of the first lines of defense, says Northrup, is to reduce salt intake. Limiting salt will reduce bloating - including water retention in the brain. That, in turn, may ease both physical and emotional symptoms. Northrup also advocates cutting out sugar and limiting caffeine, both of which can make PMS symptoms worse.
And while medical studies remain scant, Northrup also believes women should avoid diet sodas and sweets containing aspartame (NutraSweet) and foods containing MSG (monosodium glutamate). "Both are loaded with excitotoxins, chemicals that impact brain cells and can make PMS symptoms worse," she says.
In addition, Goldstein recommends that women increase intake of vitamin B6 - either by taking supplements or by adding more beans, nuts, legumes, and fortified bread and cereals to your diet. Northrup suggests increasing levels of zinc (try poultry, seafood, nuts, and whole grains), and magnesium (found in legumes, nuts, whole grains, and vegetables).
Finally, experts advise women to pay close attention to both weight and exercise, and not to take either one to extremes. "Maintaining a healthy weight - not overweight, not underweight - and exercising regularly, without overdoing it, helps to ease PMS symptoms and make them easier to cope with," says Rebecca Amaru, MD, clinical instructor of obstetrics and gynecology at the Mt. Sinai Medical Center in New York City.
For additional help, talk to your doctor about birth control pills, which can help stabilize hormone levels. In rare instances, Amaru says, antidepressant medications, such as Prozac, can be used several days a month to help control symptoms.
The perimenopause years
It can start as early as your late 30s or as late as your late 40s. It's the life change known as perimenopause, a time when egg production dwindles and hormones can take on a life of their own.
"Your reproductive years may seem to be in full swing," says Goldstein, author of Could It Be Perimenopause? "Then suddenly, you become the mirror image of puberty."
The first thing that happens, he says, is a break in the cyclical nature of your menstrual cycle with periods that become irregular - a signal that ovulation is slowing down. This, he says, can send your hormones on a roller coaster ride.
"Every woman thinks that it's the sudden drop in estrogen from not ovulating that causes the problems. But in reality, it's the fluctuation of estrogen, along with less progesterone, that is behind many of the typical symptoms of perimenopause," Goldstein says. These symptoms, he tells WebMD, include not only mood swings and sensitivity, but also hot flashes, night sweats, and memory problems.
And while there is little hard data to support the notion that bad PMS in your 20s and 30s leads to greater hormone problems during the perimenopause, Northrup believes that it does.
Perimenopause hormones: What you can do
"If you do not get your PMS under control in your 20s and 30s, it will come screaming into your 40s," Northrup says. "Perimenopause can be the mother of all PMS attacks. And it can last quite a while." As discouraging as this may sound, even the "mother of all PMS" can be tamed.
Northrup tells WebMD that, as in your 20s and 30s, your first line of defense should be dietary changes. "If you haven't already cut out salt, sugar, and white flour, do it right now," she says. "And also cut back on caffeine and wine. In some women caffeine and wine can exacerbate perimenopause symptoms."
Northrup also advocates increasing your intake of omega-3 fatty acids (found in flax seed, walnuts, and eggs) as well as increasing calcium. When it comes to diet, Northrup is a strong believer in the power of a low glycemic eating plan, which shuns simple carbohydrates like bread, pasta, and pastry in favor of complex carbs like fruits and veggies plus protein and fiber.
"You will see a major change in just one cycle," Northrup says. "In 30 days you will feel better with just these simple dietary changes."
Getting regular exercise will also help, according to Amaru, as will learning to handle stress in a more healthful way. "It's pretty much impossible to cut stress out of a woman's life," says Amaru. "But if you can change the way you handle it - go for a walk, meditate, listen to music, whatever it is that helps you to de-stress - you will see a favorable impact on your perimenopause symptoms."
If you do all those things but are still not finding relief, Goldstein says a low dose birth control pill might be the answer. The Pill works differently than hormone replacement therapy, which adds more hormones on top of the ones that are already fluctuating, sometimes making the imbalance worse. "The Pill," he says, "shuts down your hormone production completely and gives you a small, even, metered dose that is the same day in and day out. That way, he says, "you don't feel the bumps in the road as much."
According to Northrup, some women can also benefit from natural progesterone supplementation, which works to replace the hormone lost when ovulation stops. "For some women," she says, "this can have an amazing calming effect that ameliorates all the major symptoms."
Menopause and beyond - What you can do
Because menopause is defined as 12 months or more without a menstrual cycle, it's easy to assume that once you enter the Big M, hormonal activity - including the ups and downs - is pretty much over. For many women this is the case. But because there is always some level of reproductive hormones left in the body, fluctuations and at least some symptoms can continue for years beyond your last period.
"It's not that unusual to find a woman who has entered menopause and is still fighting the hot flashes and some mood-related problems," says Goldstein. Moreover, while women in perimenopause may find wild fluctuations in their desire for sex, some women in menopause experience a kind of flat lining of desire - at least for a while.
The good news: There are things you can do. For many the answer lies in natural herbs and supplements, like black cohosh and red clover. Though medical studies remain conflicted over the effectiveness of these remedies, some women report relief. And while HRT was found to have a laundry list of nasty side effects, Goldstein says that for some women, short term use can still be the appropriate answer, particularly for hot flashes.
For some women, a good lubricant is all that is needed to ease vaginal dryness and make sex pleasurable again. And for a select group of women, Amaru says off-label use of small doses of male androgen hormones - such as testosterone - can put the flame back in the fire.
Ultimately, according to Northrup, "The most important thing to keep in mind is that no woman has to suffer with hormone horrors at any stage in her life. There are answers for every woman at every stage."