It may seem impossible for any of us to know, decades in advance, when our hormone levels will drop and we are at last rendered infertile. But, in fact, we can make a darned good guess.
And it?s worth the effort. Research and experience are leading doctors to suspect there is a window of time 10-20 years preceding the obvious onset of menopause when the balance of complementary hormones starts to go off-kilter. These hormonal imbalances can trigger a variety of life-threatening conditions and set the stage for lifelong health problems we?d just as soon skip if we had the choice.
We just need to know when these imbalances are likely to start, what causes them, what the consequences are, and what we can do about them
WHEN WILL IMBALANCES START?
We know that 95% of all women enter menopause by age 55. About 25% get there early (by age 47), and another 50% get there between 47 and 52. We also know that most women stop ovulating and become infertile about 10 years be-fore menopause. Thus, we can estimate that 25% of us will stop ovulating by age 37 and most of us will be infertile by age 45.
WHAT EXACTLY DOES HAPPEN?
Perhaps the most important thing that happens between the time we stop ovulating (ages 37-45) and the time we experience menopausal symptoms (ages 47-55) is the loss of progesterone.
Normally, the ovaries make progesterone during the second half of each menstrual cycle, in the same ovarian follicle where the egg developed and matured before its release. When we don?t ovulate, we don?t make progesterone.
Unlike other sex hormones that are also produced in organs besides the ova-ries, there is no backup source for progesterone.
Aside from promoting a healthy pregnancy, progesterone is largely responsible for moderating the potentially harmful effects of strong estrogens on tissue cells every month, whether we conceive or not. Progesterone is also critical to the normal function of virtually every organ and system in the body.
If you look at an ?org chart? showing the hierarchy of hormones, you?ll find progesterone up near the top. Progesterone is made from cholesterol. (Yes, cholesterol is essential for hormone production!) All the other sex hormones (the 3 estrogens and testosterone), plus the corticosteroids, can be made from the breakdown of progesterone in the body.
So it?s clear that progesterone is important for much more than making babies. But what happens when we start to lose it?
CONSEQUENCES OF FAILURE TO OVULATE
Anovulatory cycles (cycles without ovulation) may occur at random during most women?s reproductive years.
On those months when ovulation does not occur, the uterine lining built up by estrogen gets no progesterone to soft-en it and cannot shed as completely as it should during menstruation. The breasts do not develop the number of ductal cells they ordinarily would under progesterone?s influence, leaving the secretory cells built by estrogen to fill with fluids that have too few outlets to drain those fluids.
Various cells and systems deprived of this hormone suffer. For example, bones and muscles that depend on progesterone and testosterone to rebuild and rebalance mass lost to normal remodeling processes begin to experience slightly more demolition than rebuilding during the anovulatory cycle.
When it only happens once in a while, we may suffer a light period fol-lowed the next month by an extra-heavy one, perhaps with more pronounced PMS and cramping, but the harm to tis-sues is largely reversed when that next cycle releases an egg and restores normal progesterone levels.
THE ?ESTROGEN WINDOW? HYPOTHESIS
Consider what would happen if we knew that for the next 10 years all police, government and supervisory agents of any kind would be on a mission to Pluto.
At first, most of us would go on about our law-abiding lives. But then one day we might decide to run a particularly long red light when no other cars were around. We might pay our taxes late, or lie about our income. Eventually, some of us might even steal or hurt people if a situation seemed to war-rant it.
Estrogen is like the law-abiding citizens in this scenario. It is an important and beneficial hormone. It has critical jobs to do for both reproduction and general health. In particular, it fosters cell growth and promotes blood clotting. These are desirable functions, but when allowed to run wild they cause uterine tissue to grow too much (potentially leading to DNA mutations and cancer), and clotting too aggressively (potentially leading to blood clots and strokes), among other things.
Progesterone is the law- and rule-enforcement officer in our scenario. It puts the brakes on estrogen?s wild behavior.
During that 10-year window prior to menopause, when our bodies are still making lots of estrogen but are producing little or no progesterone month after month, estrogen?s unchecked wild side can do some serious damage.
HOW DO I KNOW WHEN IT?S HAPPENING?
There are a couple of ways to find out whether or not you?re ovulating in any given month. The first is more reliable, but more costly, than the second, which just takes time, patience and a thermometer.
1. Hormone testing. You can get your progesterone level tested, either by going to your doctor to order a blood test at a local lab, or by ordering a home test kit online that uses a saliva sample. You can also use any of the fertility/ovulation prediction products on the market, though none actually measure progesterone.
2. Basal body temperature (BBT). By taking your temperature every morning before you get out of bed, you can chart indications of both ovulation and subsequent progesterone production. Your BBT will typically be on the lower side during the first half of the month (when estrogen dominates). An extra dip even lower around day 14 can indicate that ovulation has occurred. During the second half of the month (when progesterone dominates), the BBT will run toward the higher side.
If you chart your BBT every day for several months and find no little down-ward blip at mid-cycle and no general elevation in the second half, then you have reason to suspect you are not ovulating.
Your BBT evidence combined with symptoms (irregular periods, severe PMS, breast tenderness) may be enough to warrant a visit to your doctor.
WHAT CAN I DO ABOUT IT?
Here?s where things can get sticky: not all doctors will agree that it is necessary or even beneficial to supplement a woman?s hormones just because they?re low. They resist doing it when we?re obviously menopausal, and they will be even more reluctant to do so while we?re still marginally fertile.
Yet the ?estrogen window? hypothesis suggests that by supplementing progesterone when women first start skipping ovulation on a regular basis they may prevent breast cancer, and potentially other estrogen-dependent cancers as well. (One team even suggests that restoring youthful hormone levels and cycles can help us fight off a host of so-called ?age-related? diseases.)
But you can?t use a progesterone substitute (a progestin) like that used in Prempro. You have to supplement bio-identical (exactly the same as human) progesterone. And again we hit a snag because many doctors are unfamiliar with bio-identical progesterone.
WHAT IF MY DOCTOR WON?T GIVE ME PROGESTERONE?
If a test clearly shows your level of free progesterone is low (by reproductive-age standards) and your estrogen levels are considerably higher, my ad-vice here has to be: Find another doctor.
You can get progesterone products over the counter (OTC), but some may not actually contain USP (pharmaceutical-grade) progesterone, while others are very weak or may not contain it in a form your body can absorb and use.
And in any case, even OTC hormone replacement should be monitored by a qualified healthcare practitioner.
WHAT ELSE CAN I DO?
There are a number of simple tricks you can implement now to make the second half of your life much healthier.
1. Balance omega-3 and omega-6 consumption to prevent heart disease (the #1 killer of women). Increase your intake of omega-3 oils (from fish and certain nuts/seeds) and de-crease the amount of omega-6 oils (fried foods, cooking oils, fatty meats, nuts and seeds).
2. Eat cruciferous vegetables* to pre-vent cancer. These miracles of nature contain substances that not only prevent cells from mutating into cancer, they can make cancer cells self-destruct. One substance, called indole-3-carbinol (I3C), can influence your body to metabolize estrogen into a benign form, rather than into one that can cause cancer.
*Includes broccoli, cauliflower, Brussels sprouts, cabbage and kale.
3. Neutralize your body?s pH to improve bone health. Eat smaller portions of animal protein (including dairy) and larger portions of fresh fruits and vegetables. Animal proteins metabolize into acids, but the body prefers a nearly neutral environment. So when you eat protein, the body pulls calcium and other minerals out of your bones and muscles to neutralize the acid (just as we pop a Tums to neutralize stomach acid). Fruits and veggies, on the other hand, metabolize into neutralizing bases and can deliver a much bigger usable payload of bone-building calcium and magnesium than dairy.
4. Reduce the amount of plant estrogens you consume. Soy is probably the largest dietary contributor to estrogen dominance. You may eventually need the extra estrogen in soy at menopause when ovarian estrogen levels plummet, but while estrogen is still high and progesterone is low, it?s best not to make the imbalance worse.
5. Reduce the amount of xenoestrogens you consume. Microwave foods in glass containers instead of those plastic storage containers or old margarine tubs, which can contain estrogen-like chemicals.
6. Reduce your intake of hormone-enhanced meats. You don?t necessarily have to resort to free-range meats, just consume meat in moderation.
Taking these steps-with or without progesterone supplementation-can improve your life expectancy and overall health considerably, especially if you combine them with other sound health and dietary practices and get regular checkups.
If ever we needed 20/20 hindsight in advance, it?s during (and before) that 10-year window of time when potentially harmful hormonal imbalances begin to take their toll. That?s when we can really make a difference that matters!
Patricia Copley O?Connell is a professional writer with a gift for making complex subjects easy to understand. Her previous book for medical professionals-What Part of Menopause Don?t You Understand??detailed cutting-edge advances in anti-aging and hormone therapy. She has appeared on Dallas area TV and ABC national radio.
To learn more, please visit: http://www.hormoneguru.com/
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