Hormones: Surviving ‘Amy-geddon’ Part 2
I am now a little more than 5 weeks off my low-dose progestin (non-bio-identical form of progesterone), and so far, I feel great! My mood has stabilized and elevated, and for now at least, all other symptoms have abated, including the crazy water retention and ankle swelling! (More on this in the future.) As for the acne and bad menstrual cramps, they both have returned. The cramps, as always, are bearable as long as I have plenty of ibuprofen, and the acne only just reappeared last weekend with one small pimple on my chin that has since cleared up. So not bad so far.
I needed to remind myself of OB-GYN Christiane Northrup’s advise: Listen to your body and trust its natural rhythms and cycles. Hormonal changes are natural, and, unless the symptoms are so bad they prevent women from living the full, normal life they want to live, they often are better off accepting and embracing any symptoms.
“Whether or not you should take supplemental hormones at menopause depends on a number of factors, including your overall physical health, emotional and spiritual well-being, nutritional status, lifestyle, and so forth,” Northrup writes in “The Wisdom of Menopause.” “All these factors can influence how well your secondary hormone production sites are able to keep up with your body’s new needs. For some women, just learning that the symptoms of perimenopause are temporary is enough reassurance; they become willing to experience those symptoms without masking them with medicine. And once we relax and allow our fears and resistance to fade, the symptoms themselves may lesson.”
Northrup says whether to do hormone therapy and what type of therapy, etc., is very personalized and is very different for each person. Therefore, a woman should enter this stage in her life with her eyes wide open, ready to work closely and be completely open with her doctor and not accept a one-sized-fits-all, magic-bullet approach to hormone therapy. So when I read Dr. Dale Bredesen’s “The End of Alzheimer’s,” I was at first surprised and disappointed that he seemed to take this magic-bullet approach with his progesterone,estrogen and testosterone guidelines in ReCODE, his program to prevent Alzheimer’s.
Northrup is arguably the foremost authority on women’s health. She is world-renowned for her expertise. I trust her advise. So when I first read what Bredesen had to say about it, I was very frustrated. Not only does he not offer optimal levels according to where a woman is in her monthly cycle or whether she is pre-, peri- or post-menopausal, he also doesn’t even differentiate what levels a man should have versus a woman. The first thought that came into my head was, “typical man.” Sorry, guys. After I received my second round of test results a few months ago and looked more closely at what Bredesen lists as the optimal range, however, I realized it’s very wide. He allows plenty of room for the normal fluctuations of women’s and men’s hormones throughout their lives.
My progesterone was low in my last blood test – 1.42 ng/mL – but this was because the test was done at the start of the follicular (menstrual) phase of my cycle, when progesterone naturally drops. Last year, when the blood test was done closer to ovulation – the highest point of progesterone production – it was 11.1. Bredesen’s optimal range is 1-20. My estradiol (one of three types of estrogen) was 123.3 pg/ml in 2018 and 78.5 pg/ml this year. Bredesen’s optimal is 50-250 pg/ml.
I was happy. With two years of of blood tests to compare, I fit comfortably in Bredesen’s range for progesterone and estrogen on both occasions. So I feel this is one more step in ReCODE that I can check off – at least until perimenopause kicks into high gear. He says studies show that estrogens, progesterone and testosterone are likely very important in cognitive health.
“The role of estrogens – estradiol, estriol and estrone – and progesterone in cognitive function remains controversial. But there is strong evidence for such a role,” he writes, noting that estrogen binds to the receptor and activates the enzyme that promote healthy neuron growth. “Thus estrogen is a crucial player in the prevention of dementia. Not only are estrogens and progesterone important, so is the ratio of estradiol to progesterone, since a high ratio is associated with ‘brain fog’ and poor memory.”
Bredesen says the estradiol:progesterone ratio should fall in the 10-100 range. My ratio for this year’s test is 78.5 estradiol:1.42 progesterone, which equals a 55.28 ratio (78.5 divided by 1.42). I’m sitting comfortably right in the middle – I’ll take that.
Bredesen’s words on these hormones’ role in cognitive health when I first read them made me forget momentarily about what Northrup wrote. I got so caught up in wanting to follow ReCODE to the letter while also believing that my having difficult menstrual symptoms surely meant my hormone levels must be out of whack. I jumped into hormone therapy before waiting for any test results. Then when I received the results and saw they were all within Bredesen’s optimal range, I assumed it must be because I was already doing the therapy. Except, the therapy only made my symptoms worse (as described in my previous “Amy-geddon” post.) Hindsight, I believe my progesterone and estrogens were just fine all along and didn’t need to be messed with.
Testosterone, on the other hand, was a bit too low for Bredesen’s standards (5 ng/dL to Bredesen’s 6.5-15 ng/dL range). I’ve decided not to worry about this at present. I’ll be tested again next year and if it hasn’t improved, I might look into doing something about it. But for now, all is well.
The moral of this story is to once again stress how important it is to listen to and know your body and what it is telling you and to follow your own instincts above any doctor’s advice or recent study’s findings. The science of hormones in the human body is very tricky because every person is very different and so has very different needs. Northrup in “The Wisdom of Menopause” spends a very long and tedious chapter delving into hormone replacement, covering every study that shows the various health benefits and risks to both choosing hormone therapy and forgoing it. She emphasizes all the conflicting reports that are out there and stresses that new findings emerge every day regarding the big hormone question. Bredesen also says right off the bat, the role of these hormones in cognitive health is “controversial.”
So I’ve learned I need to find the right balance of following ReCODE while always listening to my body and always putting my own instincts first. If I’m not experiencing any symptoms and am feeling great, but my tests come back a bit suboptimal, I’m not going to worry about it. If the hormones start to wreak havoc and the symptoms become unbearable, I certainly won’t shy away from the possibility of hormone therapy again. For now, however, I think the wiser option is to embrace my natural self and ride the wave of the next 10 years as I enter perimenopause. After all, menopause and the accompanying hormone fluctuations are a natural part of a woman’s life and that should be respected and even honored, Alzheimer’s gene or no.