Hormones

This blog post explains how the menstrual cycle and other hormone changes affect mood.Do some women need hormonal support or antidepressants? What are the roles of natural medicine, counselling, nutrition or exercise? Click below to find out more.

Introduction

I see many women who are concerned about their energy and mood. They sometimes wonder if hormone changes or fluctuations are causing anxiety, depression, irritability, lack of motivation or poor quality of sleep.

The assessment and management of women’s mental health has a significant number of differences to mental health issues in men. For example, hormone levels are cyclical in women of reproductive age and then drop dramatically and erratically with perimenopause and menopause. Premenstrual Syndrome (PMS), Post-natal depression and menopause are associated with energy and mood changes that are unique to women.

Women are also subject to different economic, social, political and cultural influences that affect their emotional wellbeing. Dependence on a partner to support them during child bearing years can potentially be stressful.

Women experience depression far more than men.

Women have a greater frequency of psychiatric disorders than men, for a variety of disorders including mood, eating and anxiety disorders. An Australian Survey of Mental Health and Wellbeing in 1999 showed that depression was present in 6.8% in women compared to 3.4% in men in that 12 month period. The frequency of anxiety disorders was similarly increased for women, while eating disorders were found to be ten times more common among women than men.

There is increasing evidence suggesting that the reproductive hormones (such as oestrogen and progesterone) alter neurotransmitters that are implicated in the formation of a number of mental illnesses. Hence the different phases of a woman’s life cycle as well as menstrual cycle changes with the attendant reproductive hormone shifts affect mental health.

Premenstrual syndrome (PMS)

The first two weeks of a woman’s menstrual cycle are generally a time of stable mood. These stable low levels of hormones are produced largely by the adrenal glands. Ovulation occurs half way through this cycle, i.e. on day 14 in a regular cycle, and the levels of oestrogen and progesterone increase dramatically. Mood changes, fatigue, bloating, breast tenderness, acne, irritability, fluid retention and craving sweets signal an imbalance of hormones with oestrogen levels generally being relatively high compared to progesterone. A diet high in processed foods and sweets, as well as nutritional deficiencies such as a lack of iron can worsen these changes.

Pregnancy

Pregnancy is a time of dramatic hormone increases as well as potential significant changes in career, personal and relationship focus.

Morning sickness

Morning sickness is thought to be caused by a combination of factors. High levels of hormones including oestrogen, altered metabolism of carbohydrates, blood pressure (usually low) changes and other physical and chemical changes may be relevant.

Post Natal Depression

The months following childbirth are a time of heightened vulnerability to depressive mood changes. There is an abrupt and dramatic change in hormone levels after delivery. Progesterone, oestrogen, prolactin, cortisol, oxytocin, thyroid, and vasopressin may all be involved. These changes are thought to contribute to depressive mood changes in some women following childbirth.

Perimenopause

Perimenopause is a time of significant hormone fluctuations that can last two to five years leading up to menopause. Mood changes may be severe and the risk of suicide is increased. Other symptoms may include low self-esteem, lack of libido, irritability, weight gain, poor sleep (worsened by hot flushes), brain fog, forgetfulness and difficulty recalling words or numbers. It is thought that fluctuating oestrogen levels, as distinct from low stable levels, are the likely cause of this increased frequency of depression.

Menopause

Menopause can be a traumatic time for some women. In particular, the decreases in circulating reproductive hormones as well as pituitary hormone changes are thought to cause or exacerbate the onset of depression and / or anxiety in some women. Physical symptoms of menopause such as hot flushes, night sweats, vaginal dryness, poor memory and weight gain may also worsen mood changes.

Treatment issues

One reason for writing this article is to highlight addressing and treating underlying hormonal changes in addition to focusing on treating mood changes.

Do women need hormonal support or antidepressants? Will some women need both? What are the roles of natural medicine, counselling, nutrition or exercise?

Ideally, a woman will respond to a natural holistic treatment protocol where as many relevant factors as possible are addressed. Nutritional assessment and advice, an exercise program, stress management and nutritional herbs and supplements can often help balance hormone and mood changes.

Conventional pharmaceutical medication, psychological counselling and consideration of the woman’s specific cultural and social factors may be needed.

Antidepressants, like other medications, are distributed differently in women compared to in men due to differences in absorption and metabolism. The oral contraceptive (OC) pill, particularly the progesterone alone OC, can cause depression in some women and is the most commonly stated reason for women to cease taking the OC. Some of the newer combined oral contraceptives appear to be better tolerated.

Adding oestrogen is a consideration where menopausal symptoms such as hot flushes, night sweats, mood changes and lack of sleep are severe. Progesterone needs to be added in low doses unless the woman has had a hysterectomy.Even then, some progesterone may be helpful for its’ calming and sleep enhancing benefits. Potential risks of hormone treatments need to be monitored regularly and weighed against the benefits. Changing the antidepressant may also be helpful.

There is no “one size fits all” approach to treating hormone and mood changes. Ultimately it is a matter of treating each woman as an individual and allowing her to make choices that are effective and make sense to her.

Dr Peter Holsman is a qualified Medical Practitioner, Naturopath and Professional Speaker based in Melbourne. An expert in his field with over 30 years of experience, he specialises in treating people with fatigue related illnesses including digestive problems, anxiety, stress, depression, chronic fatigue syndrome, menopause, thyroid treatment and adrenal hormone concerns.

This blog discuses six key steps to help you adjust your metabolic set point, lose weight,…

The weight of the problem

Concern about being overweight is a common topic in my clinic. There are heaps of different weight loss methods and diets on offer. Where do you start and what might have been missing?

The most recent statistics state that 63% of Australians are classified as overweight or obese. This is linked to diabetes, heart disease, cancer, sleep apnoea and mood disorders.

Successful weight loss also results in improved mood, energy, mobility, self -confidence, work performance and social interaction.

Unfortunately, successful weight loss is not a simple matter of cutting back on calories. The fact is that 80% of people who lose weight put it back on within 5 years.

The body weight metabolic set point

One reason why people fail on a weight loss diet is due to the metabolic changes that happen in response to dieting. Studies show that the body may go into “starvation mode” for years after a short term weight loss attempt. For example, six years after contestants competed in “The Biggest Loser” they had a significantly lower metabolic rate than before entering the competition.

Your body weight is regulated in part by the hypothalamus in the brain. With dieting, your body and mind have one intention – put the lost weight back on.

Energy expenditure and appetite are adjusted to restore the fat mass back to the set-point.

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Six principles to lower the set-point

Unprocessed food
Adequate protein
Fat OR carbohydrate restriction
Diet Breaks
Adequate sleep
Physical activity

Low to moderate diet palatability

A relatively bland diet is generally more filling and has a greater influence on the set point. Choose unprocessed whole food in preference to refined addictive foods. Unprocessed whole foods are generally lower in calories. They also contain adequate protein and fibre that stimulate the reward centre of the brain to reduce appetite. On the other hand, progress will be slow if you choose addictive foods such as Chocolate, ice-cream, French fries, cookies, chips, cake, popcorn, cheese burger, muffin, breakfast cereal.

Adequate protein

Protein helps increase weight loss by increasing metabolism, balancing blood sugar levels and reducing hunger hormones such as ghrelin. A palm sized serving of protein at most meals is suggested.

Fat or carbohydrate restriction

There has been a lot of debate over the years about whether low protein or low carbohydrate is better for weight loss. Research is now showing that either fat or protein restriction work. The diet still needs adequate protein and calorie restriction.

Diet breaks

Research shows that diet breaks help prevent your metabolic rate from slowing down when calorie intake is reduced. Effectively, your body no longer thinks it has to overcome starvation. The result is better long term weight loss.

Adequate sleep

Your quality and quantity of sleep have a big influence on what you eat, how much you eat and whether you have the energy and motivation to exercise. In fact, sleeping may well be more important than exercise for weight loss.

Physical activity

Increased physical activity is great for general health, mood and wellbeing. Increased physical activity tends to increase appetite so the intensity of exercise and food choices need to be monitored.

What else can you do to optimise weight loss?

Self- monitoring helps you identify eating habits, such as times and places associated with eating, and potentially make healthier choices.

Keeping a diary of your food and fluid intake, calories, weight, physical activity and emotions is really helpful so that you are consciously aware of your progress.

Related topic: What Does Your Poo Say About You?

Treatment for thyroid not working: some options

Are you currently taking conventional thyroid medication, but still have symptoms of an underactive thyroid? You may feel like your treatment for thyroid is not working.

If you have medically proven Hashimoto’s Hypothyroidism and take prescribed Thyroxine (T4) such as Oroxine or Eutroxsig, but still suffer some of your original hypothyroid symptoms such as:

fatigue
brain fog
hair loss or thinning
heavy or irregular periods
dry skin
fluid retention
constipation
weight gain
depression
cold peripheries
memory impairment
muscle aches
irregular heart beat
high cholesterol

There may be an alternative that alleviates these symptoms.

Integrative and functional medicine doctors can prescribe Natural Desiccated Thyroid (NDT) for patients with proven hypothyroidism who do not feel better when taking thyroxine (T4) alone.

What is Natural Desiccated Thyroid extract (NDT)?

Thyroid extract of porcine origin has been used successfully since 1884. Thyroid extract contains the same hormones that your own thyroid would produce-T4, T3, T2, T1, calcitonin and other enzymes, and that is why some people find that natural thyroid extract works better than synthetic thyroxine (T4) alone. NDT meets the stringent guidelines of the US Pharmacopoeia and is approved by the FDA.

One grain of thyroid extract (65 mg) contains 38mcg levothyroxine (T4) and 9mcg liothyronine (T3). The dosage of NDT is adjusted according to your symptoms and blood test results. It is supplied on prescription by holistic doctors such as myself from compounding pharmacies and is not sold by conventional pharmacies.

Who Is Likely To Feel Better with NDT?

People most likely to feel better with NDT have blood tests showing levels of T4 that are in the middle or upper part of the range, but the level of T3 is in the lower part of the normal range. This means that your body is having trouble converting T4 to T3. Common reasons for this include stress, poor adrenal function with either low or high cortisol, iron deficiency, gut dysfunction and toxic metals such as mercury blocking enzyme pathways. The main image for this blog post is an example of someone with healthy levels of T4, but low levels of T3:

T3 Is More Active Than T4

T3 is much more biologically active than T4, so a relative lack of T3 can make a big difference to your wellbeing. Although the thyroid gland produces more T4 (80 percent) compared with T3 (20 percent), T3 binds nine times more strongly to thyroid hormone receptors than T4.

Divided Dosages

Desiccated Thyroid extract is often taken twice a day. The first dose is taken on waking and a second dose is taken in the afternoon, usually at around 3 pm. The major reason is that the T3 component has a short half-life and most of it is metabolised within six hours. It therefore needs to be taken twice daily to achieve consistent blood levels. The afternoon dose helps prevent an afternoon energy slump.

It is important to understand that you need to gradually increase your dosage of natural desiccated thyroid hormone (NDT) until you reach a therapeutic level. Thyroxine (T4) needs time to build up in your system so and it may take up to 6 weeks to reach a steady level. Your body also needs time to adjust to the increased levels of T3.

Avoid taking iron, oestrogen and calcium supplements at the same time as NDT, since both bind the thyroid hormones to some degree.

Your NDT Take Home Message

Some people with medically proven hypothyroidism who are taking Thyroxine (T4) find that their hypothyroid symptoms are not getting better. They ay feel their treatment for thyroid is not working.

Natural Desiccated Thyroid extract (NDT) has been helpful for many people with persisting symptoms, especially where blood tests show relatively low levels of T3.

Treatment is monitored in two ways. One is with blood tests where the aim is for T3 to be in the upper part of the range and T4 to be in the middle of the range. Perhaps the most important way to know that the treatment is working is how you feel and the disappearance or reduction of your original hypothyroid symptoms.

Dr Peter Holsman is a qualified Medical Practitioner, Naturopath and Professional Speaker based in Melbourne. An expert in his field with over 30 years of experience, his area of expertise is holistic, integrative and functional medicine to help treat people with fatigue related illnesses including digestive problems, anxiety, stress, depression, chronic fatigue syndrome, menopause, thyroid and adrenal hormone concerns.

Do you have lots of symptoms suggestive of hypothyroidism?

Three different patients with hypothyroid symptoms.

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1. Symptoms not confirmed with a blood test

PK is a 46 year old busy self- employed lady who presents with lots of symptoms which she believes are due to an underactive thyroid.

Fatigue, poor sleep, an active “on the go” mind, hot flushes, premenstrual syndrome, constipation, bloating, and occasional diarrhoea, craving sugar, weight gain and fluid retention. Enough symptoms to tick many boxes in an online hypothyroid quiz. Thyroid hormone results were in the normal, but not ideal range.

An earlier trial of thyroid medication had not helped her feel better.

What was going on?

‍Learn more: How to stop cravings

2. Symptoms confirmed with blood tests and a great response to thyroid treatment.

For many people it is a straight forward diagnosis followed by a great response to treatment. For example, I saw an elderly lady with burn marks on her shins from being so close to her portable heater. Blood tests confirmed an extreme case of hypothyroidism. Mood, weight, temperature regulation and energy were hugely better after a few weeks of treatment with thyroxine.

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3. Hypothyroidism confirmed with blood tests but still unwell despite thyroid hormone treatment.

The third group of patients have had the diagnosis proven with thyroid blood tests that are well and truly abnormal, but have experienced limited symptomatic improvement with thyroid medication. In other words, they still have fatigue, brain fog, weight gain and lowered mood.

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Why do patients need individualised tests and treatment?

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Symptoms of an underactive thyroid can also apply to other health issues.

Depression, Weight gain, Difficulty losing weight, Fatigue
Feeling cold, Dry skin, Hair loss (alopecia),
Poor concentration, Brain fog, Memory problems,
Insomnia, Sleeping difficulty, Waking up exhausted
Fluid retention, Constipation, Slow heart rate
Elevated cholesterol, Thinned eyebrows laterally
Muscle cramps at night, Decreased sweating
Multiple miscarriages and infertility, Fibrocystic breasts

Three conditions that can cause, mimic or worsen hypothyroid symptoms.

1. An Unhealthy Gut

Digestive problems often result in lots of symptoms, including fatigue, bloating, wind, gas, poor sleep, heartburn, bad breath, weight gain or loss, poor concentration, mood fluctuations, feeling cold, memory problems, brain fog, fluid retention, constipation….and the list goes on.

Eighty per cent of your immune system and neurotransmitter (brain chemistry) production occurs in your gut. So it is not surprising that poor gut health can result in lots of unwell symptoms, as well as compromise thyroid hormone function.

2. Low Iron

A recent study showed that two-thirds of women with symptoms of hypothyroidism, despite taking thyroid hormone treatment, felt better when their ferritin levels (an iron storage protein) were increased to above 100. Many of my patients have presented with Ferritin levels in the low 20s. This may be “normal” given the wide reference ranges, but it is certainly not ideal. The advice from a haematology specialist at a recent seminar is that a Ferritin below 40 is generally consistent with iron deficiency.

Iron deficiency symptoms may appear on a hypothyroid list and include extreme fatigue, weakness, pale skin, palpitations or shortness of breath, headaches, dizziness or lightheadedness, cold hands and feet.

3. Stress

Most new patients have at least one stress in their life. Work-life balance, difficult colleagues or bosses, demands of raising a family, traumatic events in the past, responsibilities to elderly parents, relatives or friends are some of the emotional challenges described.

Stress results in many biochemical and hormone changes. For example, high Cortisol blocks the conversion of thyroxine (T4) to the active T3 thyroid hormone. High cortisol also damages the gut lining, resulting in “leaky gut”.

Symptoms of anxiety and stress include panic attacks, hot and cold flushes, racing heart, tightening of the chest, quick breathing, worry, catastrophizing, or obsessive thinking. Anxiety may cause a vicious cycle of difficulties with study, work or social life

What This Means For You

In my experience it is rarely just the thyroid that is causing all your symptoms.

These are just some of the conditions and symptoms that people might blame on an underactive thyroid gland. Is your diagnosis correct? Has something been missed?

Dr Pete

PS This blog is not designed to provide a diagnosis or definitive individual treatment. I recommend that you see a holistic doctor, such as myself, for a comprehensive assessment and treatment plan.

Symptoms of an under active thyroid include fatigue, depression, constipation, weight gain and dry skin, whereas an overactive thyroid generally results in palpitations, weight loss, sweating and agitation. In practice, symptoms of thyroid problems, especially in the early stages of disease, may be vague and overlap with many other illnesses.

Thyroid problems are common. The thyroid gland is located in front of your neck and produces thyroid hormones which are essential for your energy, metabolism and general hormone balance. Problems arise when the thyroid is either overactive or underactive. Here are some examples:

Some years ago, I did a home visit to an elderly lady who was sitting in front of a bar radiator in an attempt to get warm. There were burn marks on both her shins. Blood tests confirmed a text book case of advanced hypothyroidism.

Several women have presented with fatigue and hot flushes characteristic of the menopause. Blood tests confirmed thyroid malfunction and all symptoms settled with the appropriate treatment. They did not need oestrogen, progesterone or testosterone.

Please see me or your local health care practitioner if you are wondering if your thyroid gland is playing up. A blood test with interpretation based on optimal levels, as distinct from the broad normal range, will answer your question.

Are symptoms of an under active thyroid gland enough to diagnose hypothyroidism?

What is Sub Clinical Hypothyroidism?

A number of people have thyroid blood tests that show mild elevation of thyroid stimulating hormone (TSH) and normal levels of T4 and T3 thyroid hormones.

Does this represent early stages of an underactive thyroid or are other reasons involved?

Should thyroid hormone treatment commence or is it best to wait until all numbers are definitely abnormal and a diagnosis of hypothyroidism is proven?

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What do the British Medical Journal (BMJ) Guidelines Say?

A large thyroid study of people with mild changes in thyroid function blood tests was published in the BMJ in May 2019.

A panel of clinicians, including Professor Mieke van Driel, an Australian GP academic, issued a “strong recommendation” against the therapy in adults with only slightly elevated TSH levels where the TSH was between 4 and 10mIU/L, and free thyroxine levels within the normal range.

“Thyroid hormones do not lead to important benefits for adults with subclinical hypothyroidism for quality of life or thyroid-related symptoms including weight gain, depressive symptoms and fatigue,” they wrote.

According to Professor van Driel, even putting patients on a trial of thyroid hormone could generate “unwarranted” lifelong therapy. “We saw that internationally. The prescription and consumption of thyroid hormone was increasing when the incidence of hypothyroidism was not,” she said.

NB This advice does not apply to pregnant women, those trying to conceive, or those with TSH levels above 20mIU/L.

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What Do The British Thyroid Association and Society for Endocrinology Say?

The British Thyroid Association and Society for Endocrinology disagree with the above BMJ thyroid guidelines.

They claim that patients may miss out on crucial early treatment and therefore progress to hypothyroidism.

“A particular concern … is that primary care physicians may now dismiss patients with subclinical hypothyroidism rather than institute ongoing surveillance, potentially resulting in some patients with progression of hypothyroidism being deprived of treatment.”

They also stated that the BMJ review was biased towards patients aged 65-plus. There was not enough evidence for the panel to make recommendations for younger age groups.

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My Opinion

I see lots of people with symptoms of an underactive thyroid gland. The symptoms are many and varied. The reality is that symptoms alone are not specific for hypothyroidism and other causes need to be excluded. The diagnosis does need to be clearly confirmed with blood tests.

Other common reasons for symptoms of fatigue, weight gain and mood problems include digestive problems, stress and low iron levels. Mild changes in thyroid function blood tests are often secondary to these three underlying causes.

Borderline thyroid blood test results are not enough to justify life-long medication. Blood tests can easily be monitored and thyroid hormone replacement can addressed later if needed. Integrative medicine with a holistic range of nutritional supplements, diet and lifestyle advice can make a significant difference to your overall health and wellbeing.

Related topic: Functional vs Conventional Medicine