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OMG. She's So Hormonal! Randi Hutter Epstein, MD, MPH

Updated: Nov 14, 2019

Hormone. The word is tossed about all the time, but what does it really mean? I’ll tell you what it doesn’t mean: Women Going Crazy. That’s not to say that hormones do not impact our moods. They do. But guess what? Women do not have a monopoly on hormones and the hormonal swings that go along with having them. Our husbands have hormones and so do our boyfriends, sons and even our newborn babies. And, yep, our pets, too. Yet, ever since the word hormone was concocted a little more than a century ago, there’s been confusion and quackery. It’s time to set the record straight. What is a hormone?  Hormones are your WiFi. Sort of like the way I send an email and it gets to my friend’s inbox, hormones are chemicals released from one gland that hit faraway targets. No connections needed.

Who discovered them?  The world’s first (and perhaps strangest) hormone experiment was conducted in 1848 in a German doctor’s backyard. He fiddled with a flock of roosters. Here’s what he wanted to know: Do glands and their mysterious juices work no matter where they are? Among his many experiments, he implanted a testicle into the belly of a castrated rooster. The poor thing had nothing between its drumsticks, yet a testicle was inserted within the loops of its intestines. When it had been castrated, it turned into a fat, lazy bird. But as soon as the testicle got into its midriff, it reverted to the fit, hen-chasing cock it had been in the first place. The doctor wrote up his experiment, defining hormones for the first time, and then went on his way. Who launched the field of hormones? Drs. William Bayliss and Ernest Starling, British scientists, unearthed the German discovery, conducted several more animal experiments and ultimately recognized the significance of thinking about the body in a whole new way. They needed a name for these internal secretions. So, they asked their friend, a Cambridge University classics professor, for a Greek word that meant “to arouse” as in arousing other glands in the body. He suggested something along the lines of hormoa (Greek for aroused.) Hence hormones. The name stuck.

Do they control us or can we control them?  Hormones control growth, metabolism, lust, hunger, satiety and so much more. Yes, they control us. We are learning to control them. Think about diabetics who can treat themselves with insulin so their sugar doesn't fluctuate wildly. Think about folks with low thyroid who can take thyroid medication. But we are not yet at the stage where we can turn back the clock (although we’ve tried), nor do we have hormone injections that are guaranteed to curb your appetite or boost your libido. The pill and Hormone Replacement Therapy (HRT) Both the birth control pill and hormone replacement therapy are made from the same hormones: estrogen and progesterone. What works for some doesn't work for others. For some women, the low-dose hormones work brilliantly, whether to prevent pregnancy or to ward off hot flashes. Others of us are more sensitive to the impact of progesterone, a hormone that tinkers with brain transmitters and can trigger depression. Recent studies are unraveling the mysteries of progesterone and estrogen on the brain and how they affect dopamine and serotonin levels, which are tied to happiness and mood. Today, women who feel lousy on the pill can get the same level of contraception with an IUD. Yes, there are hormones in the IUD, but they don't get into the bloodstream to the degree they do with an oral pill. For women nearing menopause, hormone replacement therapy can ward off hot flashes and vaginal dryness. But again, some women may find the bloating and depressed mood from the therapy worse than menopause.

Side effects Every medication has side effects. Life has side effects. Regardless of the popularity of estrogen and progesterone—whether for contraception or menopausal symptoms—the increased risk of heart attacks and strokes from HRT is significant for some women, particularly those who smoke. Check with your doctors—and continue to be monitored—when you start taking hormones. 

I thought menopause affected women in their 50s. Why am I 10 years younger than my menopausal friends and feel like I’m going crazy? The end of periods can mimic the beginning of them, complete with erratic, heavy periods and mood swings. Small spaces that were once cozy become claustrophobic. Here’s what’s going on: The drop in estrogen is tied to increases in adrenaline (the fight-or-flight hormone) that can make even the most laid-back women feel anxious. These initial symptoms creep up so insidiously that some women may not realize they are experiencing menopause. Here’s what we know about HRT now: For many women, it wards off symptoms such as insomnia, hot flashes and painful intercourse, but it has not been proven to prevent the chronic ailments of old age, such as heart disease and Alzheimer’s disease.  Progesterone The word “progesterone” comes from “pro” plus “gestare,” as in carrying a pregnancy. But we now know the progesterone does so much more, including interacting with receptors in the brain. That’s why some women feel utterly lousy when progesterone surges naturally—or when they are put on high doses of the hormone as part of fertility treatment. Progesterone taps into serotonin receptors—increasing or decreasing its levels depending on whether it’s matched with estrogen. Progesterone alone seems to decrease serotonin, a brain messenger linked to a feeling of wellbeing. It may also impact dopamine, the hormone tied to pleasure or rewards. Of course, how you react to progesterone may be very different from the way your BFF reacts to it. It all depends on other hormones and your unique brain chemistry. The upshot is that you should be aware that hormones have impacts that may extend beyond what their name implies.

Estrogen Estrogen comes from the Greek "oestros" (estrus, the period of sexual activity among animals) plus "genos" (generating). Estrogen is important for the menstrual cycle and pregnancy, but also for building bones and maintaining the cells that line the urethra, bladder and vulva. A drop in estrogen (due to menopause, anorexia or chemotherapy) can lead to dry skin and also a dry vaginal canal. Some studies have linked binge eating to an increase in progesterone and estrogen that occurs during the menstrual cycle. If you have issues with dryness, you can speak to your doctor about estrogen vaginal tablets. And if you seem to have binges every month, it may be helpful to realize that it may be due to hormonal fluctuations. Sometimes just knowing that it’s your chemistry—and not a weakness—can help women muster the energy to avoid temptation. Or, learn to have a bit of self-compassion if you have one night of over-eating. Bioidentical compounded hormones seem so appealing and all-natural. What’s the deal? Bioidentical means just that. These compounded hormones have the same chemistry as the hormones in your body. They are thought to have fewer side effects than drugs, which are similar to your body's hormones but not exactly the same. Big drug companies make bioidentical hormones. Compounded drugs are touted as the “Whole Foods” version of hormones, like something made in a mom-and-pop shop. And at one time, that was true. They were created for folks who had specific allergies or, say, couldn’t swallow a pill. So the local pharmacist made an allergy-free pill or syrup with the same active ingredients. Today, the compounded hormone industry has blossomed into a multi-million-dollar enterprise. And, because of a loophole in the law, compounded hormones do not have to go through the U.S. Food and Drug Administration (FDA) for approval. There is no quality control. They also do not have to have warning labels, as all FDA-approved drugs are required to do. That gives the consumer the false sense that there are no side effects from compounded hormones. Advice for HRT:

  1. Only take pills that have been tested for quality, so you know that what you are getting matches what’s on the label.

  2. There are many levels of estrogen and progesterone available. Do not be afraid to tell your doctor if you feel bloated, or are suffering from headaches. She can prescribe a different dose.

  3. Seek the care of a physician if you are taking hormones. They are not risk-free. You need someone who can keep an eye on your blood pressure and make sure you are not at risk for a blood clot.

  4. Feeling moody on the birth control pill? Tell your doctor. You may be better off with an IUD, which also has hormones but does not release the same high levels into the bloodstream, lessening the impact of the hormones on the brain and emotions.

Photo credit: Bannon-naito-518158-unsplash

Non-hormonal remedies [see also SOULFUL Insights post Ask the OB/GYN by Andy Hutchinson, MD] When it comes to menstrual or menopausal mood swings, there are no sure-fire remedies. But there are ways to ease anxiety and depression.

Meditate: You do not need to be an expert at meditation, but you need to take a few minutes every day to breathe deeply and to put aside your worries. Hormones flirt with brain chemical messengers. No matter how busy you are, you have 120 seconds to cast aside the to-do lists and focus on the sound of your heartbeat.

Chill Out: Deep breathing for about 10 minutes every day has been tied to fewer hot flashes. Focus on inhales and exhales, imagining a whoosh of air going from head to toe.

Self-Compassion: Appreciate that your hormones fluctuate and that what you are feeling right now may just be a fleeting bodily response to hormonal ebbs and flows. This, too, shall pass.

Eat Right: What you eat impacts your hormones. We all know that our toddlers need regular meals or else they get cranky. That’s hormonal. That’s sugar and insulin and leptin and ghrelin going haywire. We tend to think we grow out of that, but we don’t. Try not to wait too long between meals. That will only exacerbate the menstrual/menopausal moods.


Randi Hutter Epstein, MD, MPH

Randi is a medical writer, lecturer at Yale University, writer-in-residence at Yale Medical School and an adjunct professor at Columbia University Graduate School of Journalism.

She earned a B.S. from The University of Pennsylvania, where she studied the history and sociology of science. She earned an M.S. from Columbia University Graduate School of Journalism, an M.D. from Yale University of Medicine and an M.P.H. from Columbia University Mailman School of Public Health. Her articles have appeared in The New York TimesThe Washington PostParents and More, among other newspapers and magazines. She is also the author of Get Me Out: A History of Childbirth from the Garden of Eden to the Sperm Bank (released by W.W. Norton, Jan 2010) and AROUSED: The History of Hormones and How They Control Just About Everything (W.W. Norton, 2018).

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