Cracking the Code on Women’s Health and Hormones The field of women’s health is filled with mixed messages and confusion. It reminds me of the poem “The Blind Men and the Elephant. It was six men of Indostan to learning much inclined Each of the six men felt different parts of the elephant, and exclaimed with confidence their perception: “is very like a wall!;” is very like a spear!;” “is very like a snake!;” “is very like a tree!;” “is very like a fan!;” “is very like a rope!” And so these men of Indostan disputed loud and long, One of the first, and most important, things to understand in cracking the code on hormones is this: All of the hormones in the body, both male and female, come from cholesterol. This underscores the importance of cholesterol in our bodies, and maintaining adequate levels. From cholesterol, enzymes break this molecule into progesterone, testosterone, and estrogens. Our life-saving corticosteroids and aldosterone also emerge out of this cholesterol pathway. We will most easily understand the effects of the estrogens (of which we have three-estradiol, estrone, and estriol) and progesterone if we compare them side by side. In the uterus estrogens stimulate cell lining production, which is why the monthly period happens. The progesterone matures this lining for implantation of a fertilized egg. If implantation does not take place, this lining sloughs off and another cycle begins. Estrogen effect on the ovaries stimulates egg maturation and subsequent egg release. Progesterone, which is produced from the corpus luteum (the release site of the egg), suppresses further egg release so we don’t usually have twins, triplets or more each pregnancy. Estrogen stimulates breast tissue enlargement, while progesterone prevents cancer of the breast. Each of these two hormones has different effects on the bone. Estrogen slows bone loss, which is seen as accelerating osteoporosis around menopause, while progesterone stimulates new bone growth. There is very little progesterone produced when there are no more cycles, as the corpus luteum no longer exists each month. Estrogens interfere with thyroid hormones, while progesterone facilitates their function. In the brain, these hormones have very different effects. Estrogen stimulates function and sharpness, which explains why so many women complain of ‘brain fog’ after menopause. Progesterone calms the mind, acting like a natural anti-depressant. Estrogen deposits fat in the hips and thighs. (Testosterone places fat in the abdomen, which explains the difference between men’s and women’s fat deposition.) Progesterone burns fat. Estrogen stimulates the creation of progesterone receptors, so progesterone can work more effectively in the body. Progesterone up-regulates the estrogen receptors, so they function more efficiently. Estrogen increases water retention, thus hydrating the skin. Progesterone acts as a natural diuretic. As a general rule, estrogen decreases libido; progesterone increases it. A few other things that estrogen does with no progesterone effect include its ability to maintain endothelial lining of the blood vessel wall, and increase collagen production, which facilitates faster healing and softer, more elastic skin. Testosterone prevents bone loss, and restores energy, drive, and motivation. It enhances libido, but is only one component of many that contributes to sexual drive. (It is the major component in men). To a small degree, testosterone will relieve menopausal symptoms. It increases lean body mass and builds muscles, which is why it is categorized as a controlled substance because of its abuse potential in body builders. It also decreases insulin resistance, the first step toward diabetes mellitus type II. Estrogen Dominance Now that we have a background with basic hormone principles, let’s define a term called estrogen dominance. This means that estrogen is excessive relative to progesterone. These effects are manifested in any number of ways, many of which make sense because we now understand the function of estrogen. Water retention, breast tenderness, breast lumps and cysts, moodiness/high emotion, feeling anxious/feeling depressed, having decreased libido, having bleeding or clotting or cramping-these are all extensions of estrogen effects without the modifying component of progesterone. Fibroids, endometriosis and polycystic ovarian syndrome are also associated with estrogen dominance. Estrogen Deficiency Now let’s turn our attention to estrogen deficiency symptoms, often thought of as menopausal symptoms. Not everyone has any or all of these symptoms, so don’t feel deprived if you pass through this phase joyfully with no side effects! The hot flashes and night sweats, along with mental fog and forgetfulness, are some of the most troubling. Night sweats may interfere with sleep, with insomnia’s attendant devastating side effects. Mood changes with anxiety or depression are not uncommon. Dry eyes, dry skin, and vaginal dryness can be a nuisance, and may even result in tearing or cracking. Pain and stiffness, palpitations, headaches, and bloating are other troublesome symptoms that occur with these changing estrogen levels. Treated Safely Can women be treated safely for these symptoms? YES. They can also be treated un-safely for these. Through the years, women have been guinea pigs for unstudied ‘fake’ estrogens (extraction of non-human estrogen from pregnant mares call Premarin) and ‘fake’ progesterone that should have been called progestins. When the first scientific study of these hormones was initiated, called the Women’s Health Initiative Study, it had to be discontinued early because the side effects were so great in the treated group as compared to the placebo group. These side effects were mostly vascular, including increased heart attacks, strokes, and clots in veins, lungs and retina. The risk of endometrial and breast cancer also increased. Interestingly, the same day this data was released, another large study on HRT (hormone replacement therapy) showed an increase in ovarian cancer. There were also doubled risks of dementia (probably from TIAs, transient ischemic attacks which are small strokes) and surgical removal of gall bladders. A growing group of physicians have been treating these symptoms with hormones that are chemically identical to what the body produces, presently called bio-identical hormones. These hormones can be metabolized through pathways the body already uses and has used for years. Most of the symptoms can be treated just as effectively with these chemically identical products. In treating my patients, my first hormone of choice is progesterone. Because of its ability to up-regulate estrogen receptors, often this choice by itself will relieve menopausal symptoms, and most certainly will assist in the problems of estrogen dominance. In pre-menopausal individuals, it has been used to regulate periods, as it is the cycling of progesterone that acts as the trigger to initiate menstruation. Much controversy exists over the use of hormones to prevent osteoporosis in peri- and post-menopausal women. FSH (follicular stimulating hormone) is part of the cycle and stimulates the follicle (egg). When estrogen levels drop at menopause, FSH goes up in some women. FSH interferes with bone metabolism if the level stays above 80. If FSH is high, this represents a medical indication to treat with hormones, first with progesterone and additionally with estrogens if needed. If progesterone is not adequate to control the menopausal symptoms or to bring the FSH levels down by itself, then estrogen can also be used. Progesterone and estrogen are available in many forms, including oral, transdermal, pellets, sublingual, and patches. Each has advantages and disadvantages; it truly is individual preference. Actress Suzanne Somers has been a strong advocate for bio-identical hormones. Her contention is that women feel best in their 20s and 30s when they are menstruating on a regular basis. High enough doses of estrogen and cycling of progesterone can mimic the body’s former levels and produce periods in women for years after normal menopause. I am not aware of any increased risk using high verses low doses of the chemically identical hormones. Again, this treatment is an individual choice. Many women are happy with minor adjustments in their hormone levels as they age. There is much study that has yet to be done in this field. Until the unbiased science is out, my first choice will always be with bio-identical products instead of chemically altered ‘fake’ products, herbs instead of drugs, and balance and moderation in all things. For more information, or to ask me questions, please feel free to visit my website, www.stangardnermd.com. To your dynamic health and energy! Dr. Stan Gardner No Comments | Post or read comments FEATURES |
May 8, 2026
May 8, 2026
