Women_s Health-Hormones and Stress

1. Women’s Health:
Hormone Balance and
Stress
Henri J Roca, MD
Assistant Professor, Department
of Family Medicine, University of
Arkansas School of Medicine

3. Estrogen and Progesterone
 During reproductive years, ovaries
make high amounts
 Estrogen peaks at the beginning of cycle
 Progesterone peaks after ovulation
 Small amount of both made in Adrenal
glands
 Some estrogen also made in fat cells

5.  Hot flashes, flushes, night sweats and/or cold
flashes, clammy feeling
 Bouts of rapid heart beat
 Irritability, Mood swings, sudden tears
 Trouble sleeping through the night (with or
without night sweats)
 Shorter, lighter periods; heavier periods,
flooding; phantom periods, shorter cycles, longer
cycles
 Loss of libido
 Crashing fatigue
 Anxiety, feeling ill at ease
 Feelings of dread, apprehension, doom
Symptoms Associated with Menopause

6. Reproductive Hormones and
Dental Health
J Midlife Health. 2014 Jul-Sep; 5(3): 115–120; Ann Med Health Sci Res. 2013 Jul-
Sep; 3(3): 320–323.
 Estrogen receptors in oral mucosa similar to
vaginal mucosa
 Natural menopause is defined as a
spontaneous cessation of natural
menstruation for 12 consecutive months at
45-55 years of age
 paucity of saliva, increased dental caries,
dysesthesia, taste alterations, atrophic
gingivitis, periodontitis and osteoporotic jaws
unsuitable for conventional prosthetics or
dental implants. calcified carotid atheromas.

7. ORAL MANIFESTATIONS
 Effect on periodontium
 Periodontitis
 Oral candidiasis
 Localized osteitis
 Burning mouth
 Trigeminal nerve involvement
 Xerostomia and increase caries activity
 Delayed healing

8. Progesterone and Pregnancy
 Increased in puberty, with OCP, during
pregnancy
 Changes in blood flow – red gums, more
reactivity to plaque
 Acid erosion
 morning sickness or esophageal reflux.
 Periodontal disease occurs in 50% to
100% of all pregnant women

9. Peri-Menopause
 Time from when symptoms start, lasting to 1
year after last menstrual period
 Symptoms:
 Increased PMS
 Irregular periods, or changes in length and flow
 Hot flashes, night sweats
 LH and FSH will be elevated: trying to get
the ovaries to make estrogen
 Ovaries respond with periodic bursts: Hot
Flashes

10. Hot Flashes
 80% of American women will have at least 1
hot flash
 Surge of power, heat, or energy being
released
 Some completely debilitated
 Thought to result from fluctuations in
estrogen levels
 During peri-menopause, but can continue
into menopause
 Exacerbated by low progesterone levels

11. Peri-Menopause
 Progesterone levels decline due to lack
of ovulation
 Increases in frequency through the 40’s
 Too much estrogen relative to
progesterone
 Estrogen Dominance

12. Estrogen Dominance
 Common symptoms
 Fibrocystic breasts
 Fibroid tumors of the uterus
 PMS symptoms
 Breast tenderness and water retention
 Mood changes
 Menstrual symptoms
 Menopause symptoms - especially hot
flashes

13. Menopause
 Decreased estrogen and progesterone levels
 Begins 1 year after last period
 Low Thyroid and/or low adrenals will make
symptoms worse

14. Burning Mouth Syndrome
 43% peri and menopausal; 6%
premenopausal

17. Xerostomia
 Estrogen receptors in salivary glands
 Flow rate including stimulated flow
rates are lower in postmenopausal
women
 Salivary pH and electrolytes are
unaffected
 Mandibular dysfunction, diffuse gingival
atrophy or oral ulcerations, oral
candidiasis, pernicious anemia

18. Periodontal Health
 Estrogen receptors in periodontal
osteoblasts and fibroblasts
 Decreased vascular flow in menopause
 Worse and more frequent periodontal
disease

19. Alveolar Bone Loss
 Strong association with osteoporosis

21. Exercise
Acupuncture
Manipulative
Therapies
Phytonutrients
Minerals
Vitamins
Diet
Yoga
Biofeedback
Homeopathy
Counseling Meditation
Psychological
and Spiritual
Equilibrium
Hormone and
Neurotransmitter Regulation
Detoxification and
Biotransformation
Structural
Integrity
Immune
Surveillance
Digestion,
Absorption,
and Barrier
Integrity
Oxidative
Reductive
Homeodynamics
Inflammatory
Process
Infectious micro-
organisms
Structural or
physical damage
Nutrient
insufficiency
Xenobiotics
Radiation
Emotional
trauma
Spiritual
angst
Nutrient excess
Food toxicants
(allergens, stimulants
etc,)
Drug side effects
Adiposity
Toxic metals
Aging
Genetic pre-
disposition
(SNPs)
Disrupted light
cycles – circadian
dysrhythmias
Hyperglycemia
Hypoglycemia
Excessive
exercise
Excessive noise
Situational
stress – fear,
anxiety, worry
Dysbiosis
The holistic/ functional
medicine model
recognizes and prioritizes
the patient’s full, unique
story and
uses fundamental clinical
imbalances as a key
to treating complex,
chronic illness.

22. BRUXISM
ENTER THE MATRIX

24. Adrenal Glands
 2 glands, located on top of each kidney
 Cortisol: main stress hormone
 Sex hormones also made here
 DHEA, Testosterone, Progesterone, Estrogen
 As we age, Ovaries make less E and P
 Adrenals pick up the slack
 Healthier the adrenals, easier the transition to
menopause

25. Acute Stress
 High Cortisol
 Initially DHEA can be elevated
 Eventually, DHEA, T and E decrease because
all raw material is being diverted to make
Cortisol
 High Cortisol is good in acute situations:
 Increased blood sugar for fuel
 Shunt blood to periphery to run
 Decrease inflammation to manage response to
injury

26. Chronic High Cortisol
 Raises blood sugar - insulin/diabetes
 Abdominal obesity - risk for metabolic
syndrome
 Fluid retention and hypertension
 Breakdown of structural proteins - muscle
(sarcopenia), bone and connective tissue,
hair and nails
 Impairs immune system
 Chronic infectious diseases
 Lowers sex hormones

27. Chronic Stress:
Adrenal Fatigue
 Eventually, low Cortisol
 Saliva testing
 Low DHEA, Testosterone
 Less Estrogen and Progesterone
 Worsens symptoms of peri and menopause
 Symptoms:
 Fatigue
 Hair loss
 Joint pain and inflammation
 Allergies
 Auto-immune disorders

29. Thyroid Gland
 Low functioning - hypothyroidism
 High TSH, low T4, T3
 Nutritional causes- iodine, zinc, selenium, iron
 Auto-immune - Hashimotos Thryoiditis
 Symptoms
 Low body temperature, cold hands
 Sluggish metabolism, weight gain
 Fatigue
 Constipation
 Depression
 Low libido
 Menstrual disorders, severe menopausal symptoms
 Hair loss, dry skin

30. Thyroid Hormones
 Thyroid gland makes T4 (4 iodine molecules)
 T4 delivers an iodine to all cells in your body
and is activated to T3
 T3 much more potent
 Many people have subclinical
hypothyroidism from low T3, or problems
with activation of T3, or removal of wrong
iodine
 Dependent on progesterone and cortisol,
among other nutrients (more later…)

31. Stress Issues and
Achieving All-Hormone
Balance

32. Stress and Thyroid
Function
 Stress suppresses hypothalamus’ release of
TRH, the pituitary’s release of TSH, and
thyroid gland production of thyroid hormone
 Decreased TSH, T4, T3
 Chronic stress: don’t convert T4 to T3
 Inflammatory cytokines - block conversion
 Adrenal exhaustion - low cortisol
 Cortisol needed for T4 to T3 conversion
 Healthy Adrenals Key to Healthy Thyroid

33. Stress and
Estrogen/Progesterone
 High Cortisol causes worsening of
Estrogen Dominance, low Progesterone
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34. Progesterone and Thyroid
 Progesterone helps convert T4 to the
activated form of T3
 Stress, adrenal fatigue and Peri-
menopause/menopause all cause low
progesterone
 Negatively effect the thyroid
 Can’t balance thyroid without balancing the other
hormones

35. Treatment approaches:
Perimenopause
 Chastetreeberry (Vitex): balances
estrogen and progesterone
 Compounded progesterone cream
 Hot flashes
 Not Effective:
 Wild yam cream
 Dong Quai root
 Evening Primrose
 Vitamin E
 Ginseng

36. Treatment Approaches:
Menopause
 Mind-Body Medicine: Studies show
reduction of hot flashes with:
 Relaxation
 Self-suggestions of cool thoughts
 Temperature feedback
 Training in slow deep breathing
 Black cohosh (Remifemin 20 mg twice)
 Isoflavones from soy, kudzu
 Soy: Exact mechanism not known. Possibly
by weak estrogenic activity: blocks harsher
estrogens

37. Treatment Approaches:
Menopause
 Bio-identical Hormone Replacement
Therapy: Bio-HRT
 Vaginal Dryness:
 Estradiol only Estrogen cream: Estrace: 2
grams per night X 2 weeks, then 1 gram, 1-2 X
week.
 Sexual activity will increase mucus
 Avoid excess douching

38. Treatment Approaches:
Thyroid
 Iodine, Zinc, Selenium, Vit A
 Kombu
 Brazil nuts
 Thyroid hormone replacement
 Synthetic T4, T3 (Synthroid, Levoxyl,
Thyrolar, Cytomel)
 Natural T4, T3 (Armour, Naturthroid)

39. Treatment:
Adrenal Fatigue
 Lifestyle factors
 Nutrition: Low sugar and not skipping meals
 Stress Management: physical and emotional
 Sleep - 7-9 hours
 Exercise - not too much or too little
 Remove toxins - caffeine, alcohol, drugs,
environmental
 Targeted Supplementation

40. Adrenal Supplements
 Herbs, including Rhodiola - adaptogen
 B5, B6, Vit C
 L-tyrosine - especially good for
depression, low energy
 Licorice root - especially for
inflammatory conditions

41. Mind-Body Techniques
for Balancing Stress
Hormones
 Relaxation
 Breathwork
 Autogenics and
Biofeedback
 Meditation
 Imagery/Self-
hypnosis
 Exercise
 Prayer

43. Bone Building
 Estrogen
 Testosterone
 Raloxifene
 Calcitonin
 Exercise
 Sunlight
 Vit D
 Calcium
 Magnesium
 Boron
 Strontium
 Orthosilisic Acid