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Post by Karen on Jul 9, 2011 8:15:39 GMT -5
Last week, I was looking for a good, well-rounded book on hormones and stumbled across this book while reading a review for another book that I was considering. It's called "Screaming to be Heard: Hormone Connections Women Suspect... and Doctors Still Ignore" by Elizabeth Lee Vliet, MD. It's a big book (600+ pages) and I suspect a lot of it is dense and I probably wouldn't recommend it for the average person, but if you guys thought I knew a lot about hormones before, just wait!!!!
The book is a bit outdated (last revised in 2001) so I suspect there are some newer treatment options these days, but despite that, it appears to be a complete guide on overlooked and ignored hormone connections, women's health issues, women's advocacy, and treatment options. All the reviews I read said she has a very balanced approach with both synthetic and bio-identical hormone supplementation. And she's not trying to sell any particular product. (She has her own practice that does phone consults, but I looked up the prices and they are outrageous!)
Although it covers a lot of women's health issues, there's not a single mention of endo in this book, which is why I'm keeping this thread in the general chat area. However, it appears that she has other books out there that go into more detail with things like PCOS and I believe endo that I'd eventually like to get my hands on.
I'm just starting out and already have had so many ah-ha moments! I'll do my best to summarize the bits I think are most relevant to us.
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Post by Karen on Jul 9, 2011 8:30:32 GMT -5
Here are a few tidbits from Chapter 1, titled: Screaming to be Heard! Listening to Women's Voices
- The medical system often views women as over-utilizers of the medical system. That's because we're very much in tune with our bodies and press for answers. But, because modern medicine is based on research on male physiology and function - NOT females - we often don't get the treatment and answers we need.
- Women are told much more than men that our symptoms are due to stress or anxiety. But, if we've gone through x years of our life handling stress and anxiety without all those symptoms, is it really feasible to say that all of a sudden, we just happen not be able to handle stress and anxiety? Nope! That just doesn't make sense!
- The menstrual cycle affects drug metabolism and interactions, but few studies have been done to determine how to adjust doses accordingly throughout the cycle.
- Women often weren't included in medical studies in the past because hormonal changes every month 'clouded' the data - men were much preferred because their hormones are relatively static all the time. But, because of the hormonal changes every month, women SHOULD have been studied, and should be studied in much more detail!
- The media focuses on breast cancer, which distorts the impact and importance of other significant health issues that affect women.
- The traditional approach to supplement hormones (either through BC or synthetic hormone replacement) is usually a one-size fits all approach. But that doesn't make sense... You wouldn't have all diabetics use the same dose of insulin, would you? Women require an individualized approach.
- The author's advice on being heard: "My personal advice for her is to be a well-informed, knowledgeable, articulate 'squeaky wheel' armed with thought-out questions, organized symptoms, and a brief history." In addition, she suggests we, "Vote with our feet by changing physicians and other health professionals when we feel we are not being listened to adequately." (I think all the ladies here on ER would give this a big 'ol AAAAAAAAMEN!)
- What's the current motivator of women's health these days? $$$ According to the author (assuming around 2001), $2 out of every $3 spent in healthcare is by women. There's a fortune to be had if researchers and drug companies start to focus on women's health issues. (Though in my personal opinion, this could be a bad thing, too, as people scramble to get anything out there, whether it's good or not.)
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Post by Karen on Jul 9, 2011 9:50:41 GMT -5
Chapter 2: Hormones: A Guide to Your Body Cycles- We often think of hormones having a few specific functions, usually only in regards to our girlie parts. In reality, though, hormones are essentially chemical connectors that carry messages to and from all organs of the body, and connect one organ's function to another to keep the body balanced and working optimally. - Think of each hormone like a key. Hormones (keys) have to fit precisely into a receptor site (lock) in order for them to work. Some keys may fit into some locks, but if they don't fit exactly, the lock won't open like it's supposed to. That means the cell won't function properly, which means you can feel the effects of missing that particular hormone. - Think of this in terms of BC... BC imitates the keys of our natural hormones, but in order to be patented, they key has to be slightly different than our natural hormones. So, they BC key doesn't fit exactly like a normal hormone key would.
- So even though you're taking a BC pill that may be a combination of estrogen and progestin, you may not get the same effect as if your body produced those same hormones or you took a bio-identical version.
- In addition, those synthetic 'keys' may attach more strongly to the 'locks', so it may take your body longer to metabolize them. (No WONDER a lot of us feel so different on hormonal BC!)
- Hormones affect the brain, and the brain affects hormone production. (It's not in our heads!!!!!!!!!!!!!!) - Think of mother nature's intentions for the female body: pregnancy. - If your body is under a lot of stress, the body protects you from pregnancy (further stress) by suppressing hormone production.
- Estradiol stimulates the release of LH, which stimulates ovulation. Once you ovulate, estradiol drops quickly. Ever have a ovulation headaches, mood swings, or sleep disruptions? That's why!
- Progesterone is the dominant hormone after you ovulate. It helps prepare the body for pregnancy. Some of the other things that prepare you for pregnancy are water retention, increased appetite, slower GI tract (so your body can absorb more nutrients), etc... No WONDER we feel so bloated, constipated, have cravings, etc. in the second half of our cycles!
- Progesterone has a tranquilizing effect. If your body is trying to get an egg to implant, of course it would want you to slow down! This explains the sluggish feeling during the week or two leading up to your period, or if your pregnant, why you feel so sluggish right away.
- Because our lifestyles are much different than they were for a typical woman even 100 years ago, we tend to have a lot more hormonal symptoms because of completely different diets, activities, etc. Now all these things that our bodies do to prepare us for pregnancy each month seem really exaggerated, and seem more like symptoms than what our body is hard-wired to do.
- If we can learn to make healthy changes to our lives and understand what our bodies are really trying to do, we can find more positive ways to cooperate with our bodies and get them back into balance instead of fighting with them.
- We have a lot of hormones circulating around. Some are 'free', meaning they are available for use in the body, and some are 'bound', meaning they are just circulating around but the body can't really use them. Some medications can upset that balance. For example, BC can cause more of the thyroid hormones to become 'bound', which means those thyroid hormones aren't available anymore for the body to use. The result? Having hypothyroid symptoms despite having normal thyroid levels!! - Thyroid disorders are 8-20 times more frequent in women than in men, and can cause changes in a women's cycle, PMS, infertility, depression, post-partum depression, etc. Yet, a lot of women are told everything is normal WITHOUT having a full thyroid workup including TSH, free and total T3 and T4, and antibodies. - The brain is often first to show the effects of decline in ovarian or thyroid function becuase it depends so heavily on these hormones.
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Post by Karen on Jul 9, 2011 10:10:08 GMT -5
Sorry, I'm realizing that I'm posting a lot more on this than I intended!!!! If you're finding this useful, I'll continue, but if not, I'll stop! I'll be taking a break from reading today for a bit.
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Post by KSA on Jul 9, 2011 14:23:51 GMT -5
Thank You so much Karen WOW! I looked right away to see if I could get this book in and we do have available copies in Toledo:)
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Post by JC on Jul 10, 2011 9:29:46 GMT -5
"- The media focuses on breast cancer, which distorts the impact and importance of other significant health issues that affect women."
Ugh... this has always frustrated the hell out of me.
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Post by Karen on Jul 10, 2011 14:01:54 GMT -5
Me too... I remember you sharing some of the info about women not being studied much at all until recently and really chaps my ass when I saw all the instances that it affects us women!
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Post by JC on Jul 10, 2011 15:13:11 GMT -5
Yeah that totally weirded me out when I heard that all medical research was done on white males only. Even minorities weren't included.
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Post by 1234 on Jul 10, 2011 17:59:20 GMT -5
Karen, your research is so helpful. Thanks for it.
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Post by Karen on Jul 16, 2011 13:55:38 GMT -5
Ok, so chapter 3 is called: Hormones in the Brain, though I think it should be retitled as "It's NOT in your freaking head". There's so much info in this chapter but I'll try to keep it to the main points.
**Let me also say that this book doesn't deal specifically with endo, but since we all have hormonal problems, a lot of these pertain. I also want to mention that a lot of us are told that estrogen is the bad guy when it comes to endo, and it is when unbalanced and unchecked, but regardless, we DO need estrogen in our bodies. It affects so many other things that just our reproductive organs.**
- Neurotransmitters such as serotonin, norepinephrine, dopamine, acetylcholine, and GABA are incredibly important when it comes to hormonal influences on mood and physical symptoms. Think of them as chemical messengers. Hormones can increase or decrease the release of neurotransmitters. Despite what doctors may tell us, hormones DO affect our moods!!!
- Depression is a biological disorder based on changes in these chemical messengers and has nothing to do with willpower.
- Some vague medical problems, such as IBS and fibromyalgia are often aggravated by serotonin and norepinephrine imbalances and a loss of estradiol.
- Changes in hormone levels affect the amount of and sensitivity of neurotransmitters. Think of big milestones - puberty, pregnancy, postpartum, menopause - all times where there are big shifts in hormones, which explains why there are a lot of physical and emotional changes during these times. If you're on any sort of hormonal supplementation and notice emotional changes, that could be in part why.
- Women are often told, though, that these 'hormone changes' are all in our heads. If it's all in our heads, though, how come most of us can sense our bodies changes prior to our periods? Are we all making this up? NOPE!
- Many women that no longer get their periods can still sense the changes in their body - bloating, constipation, big boobs, etc. That's because the ovaries still cycle in some regard, though many doctors refuse to believe it. (Anyone get PMS symptoms while on continuous BC?...)
- If a woman has had a hysterectomy but still has her ovaries, she may notice a more quick decline in ovary function because when arteries are tied off to remove the uterus, it also affects blood flow to the ovaries.
- The majority of women in their 30s and 40s that describe worsening PMS symptoms have below normal levels of estradiol.
- Both hormones and anti-depressants increase production of neurotransmitters, but some research shows that anti-depressants work better when the levels progesterone and estradiol are optimal. Some women benefit from having a lower dose of antidepressants during the first half of their cycle, and higher doses during the second half.
- Women are far too often given anti-depressants rather than looking at hormonal imbalances. There's certainly a time and a place for them, but cyclic mood changes often respond better to estradiol supplementation. But, anti-depressants are patented and can make a lot more money so they are prescribed more... And it's also much easier to prescribe an anti-depressant than help a woman fine-tune her hormones properly.
- High or unbalanced levels of progesterone can have a sedative effect, and can also decrease how much estrogen and testosterone can be used by the body. Some types of progesterone supplementation can, once broken down in the body, produce metabolites that act as very strong depressants that can be as potent as valium. Hormone supplementation is all about balance.
- Ever wonder what causes hormonal symptoms such as hot flashes, GI problems/IBS, insomnia, anxiety, heart palpitions, etc? + When ovaries produce less estradiol... + The brain receives less estradiol... + In turn, the brain has less endorphins, which causes a burst of norepinephrine... + So, the brain responds to the norepinephrine, which causes increased heart rate, palpitations, rising blood pressure, etc. This can wake you from sleep, dilate the blood vessels and trigger hot flashes, cause butterflies in the stomach, diarrhea, and headaches.
- A lot of our mood swings are from a combination of hormonal changes and external stresses.
- Menopause is NOT due to a Prozac deficiency. It's a loss of hormones...
- Taking the time and money to address all these underlying hormonal problems is worth it in the long run because it gets to the root of the problem instead of putting a band-aid on things.
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Post by JC on Jul 16, 2011 23:05:42 GMT -5
This is why I HATE diagnosis such as IBS and fibromyalgia. Those are just symptoms that have an underlying cause! I wish there was some standard way to check all this stuff. It seems like doctors don't want to even try to understand a woman's hormone imbalance and instead just pump us full of drugs. Ugh it's maddening!
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Post by painttheseconds on Jul 17, 2011 0:52:33 GMT -5
Thanks for sharing all this wonderful info Karen. It's very interesting and informative.
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Post by Karen on Jul 17, 2011 8:32:49 GMT -5
I thought of the two of us with our low neurotransmitters! They kept coming up throughout the chapter so I'm not sure if I did them justice. Didn't you say you were thinking of going off BC? I would be curious to see if your neurotransmitter level change after you're off them and you feel different.
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Post by KSA on Jul 17, 2011 9:42:15 GMT -5
Jenaya you are so right most docs dont want to even deal with us. My neurologist tho gets it he can be a real a~~ but my doc that does the botox treatments was pretty clear who he treats for the most part WOMAN. Shocker we have the headaches, the hormone changes the fatigue, endometriosis and so on. I hate Chronic Fatigue and IBS diagnosis that is a cop out for docs who wont research more and it is a easy shut up to most patients. Well except us LOL we wont take the diagnosis we want to know the REAL problem!
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Post by Karen on Jul 31, 2011 8:08:33 GMT -5
Ok, so here's a snippit of Chapter 4: Hormones of Pregnancy and Stress: Progesterone and Cortisol. I've done a lot of reading on progesterone and have learned some stuff in here that I hadn't known before. Truly was an interesting read! Essentially, she argues that there's so much talk about progesterone being a miracle cure for everything, but it's important to note that we have LOTS of different hormones, and they all have their own purpose. - Progesterone is the hormone that prepares the body for pregnancy. It gets its name from that - 'pro-gestation'. It's the dominant hormone after ovulation and, if an egg is fertilized, will help your body sustain the pregnancy. For that reason, progesterone does a lot of things along those lines: makes you want to eat more (to get nutrients to an embryo), makes you want to eat more carbs (for quicker energy), slows the GI tract (so you can absorb more nutrients for an embryo), suppresses the immune system (so your body won't attack an embryo). - For your body to convert all precursors your body produces into various hormones, you need functioning ovaries. If you have had a serious illness, have been under prolonged stress, have had a tubal ligation, your ovaries may not be functioning properly and may not be able to convert all the precursors into the necessary hormones your body needs. (I think this may be one of the factors in my situation.) - The various sex hormones start out as cholesterol, then through a series of conversions get converted into progesterone, and progesterone eventually gets converted into the other sex hormones. Again, if your ovaries aren't functioning properly, you may not be able to produce the quantities of the hormones you need. - There is a big difference between progestERONE and progestIN. ProgestERONE is what is either found in the body or is molecularly the same as what is found in the body (such as bio-identicals). ProgestIN are molecularly different than what is found in the body (such as BC), and act similarly to progestERONE in some degree or another, but not exactly... There are further classifications of progestins: - Progestins such as Provera/Depo-Provera start out as progesterone and are converted into a progestin. Side effects are often mood related, bloating, or loss of libido.
- Progestins such as Micronor and Norplant are androgenic progestins - they start out as a testosterone molecule and are converted to progestin. These progestins often cause fewer issues with mood and libido. Progestins such as norgestimate and desogestrel are least androgenic so they'll cause less acne, but more likely to cause weight gain, loss of libido, etc.
- When weighing side effects of a progestin, there needs to be a balance between progestin and androgens, and a balance between progestin and estrogen.
- "Progestin-only products (that is, contain no estrogen) like Norplant and Depo-Provera, as well as pills such as Micronor, typically have the worst side effect profile of all, because you get all the negative effects of the progestin without any compensating benefits of the estrogen unless estrogen is added as a separate pill or patch." No WONDER so many of us felt so awful on progestin-only BC!!!
- Progestin-only BC is not recommended for women with fibromyalgia (sp?), IC, migraines, etc. because they often increase pain...
- Why even make progestins? Why not just use bio-identical progesterone? When progesterone was first researched, it wasn't successfully used orally because the stomach would break it down too quickly for it to get into the bloodstream. It was found that if progesterone was suspended in oil and injected, it was effective and has been available since the 1940s. But, it wasn't realistic for wide-spread use as an injection. So, a tablet that could be taken orally was developed and the progestins were born. Eventually, it was found that progesterone could be micronized and used successfully in pill form, but by then, progestins such as Provera had already taken off. Compounding pharmacies started making micronized progesterone (bio-identicals) in the 70s but were typically not covered by health insurance and Provera was, making it more likely that doctors would prescribe a progestin. There are now a few FDA approved forms of micronized progesterone - Prometrium is one of them - but doesn't have the dosage flexibility that a compounded version has. In the author's practice, bio-identical progesterone typically has far fewer side effects than progestins such as Provera. - Some of the metabolites of progesterone can have a sedating effect. If you're on too high of a dose, it can be TOO sedating. - Progesterone can also help you regulate pain by increasing endorphins (estrogen helps, too). This is especially helpful in pregnant women and, apparently, has been widely studied. Crazy! In non-pregnant woman, when our hormones drop prior to our period - boom - our pain thresholds drop! This explains why women with certain chronic pain issues have more pain just prior to / at the start of their periods! - Using progesterone is all about balance. You never want to use super high doses. Higher doses of progesterone doesn't correlate to higher benefits. It's all about mirroring what your body should be doing naturally. Too much progesterone can throw off your insulin, growth hormone, and cortisol levels and can cause some serious weight gain! - Remember - progesterone is all about preparing the body for making a baby. High levels of progesterone relax and loosen the ligaments of the back and pelvis to allow enough room for a baby's head to make its way out of the birth canal, which is why pregnant women often have a lot of back issues towards the end of their pregnancy. But, in non-pregnant women, high levels of progesterone during their luteal phase (after ovulation), can have a similar effect. No WONDER women often have back issues prior to their periods!!! - Progesterone and estrogen work together to regulate your metabolism by altering enzyme activity. Estrogen lowers body fat, and progesterone increases it. After all, progesterone is all about baby-sustaining, and if you're pregnant, your body stores extra fat to help support a pregnancy. (This is the EXACT opposite of what doctors have told me through the years, and when I gained massive amounts of weight on progstin-only BC, I was scoffed at. Grr!) A BALANCE between progesterone and estrogen is critical for managing weight.
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