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Ovulation is Crucial

Ovulation is Crucial to Women’s Health

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy

ovulation is crucial to women's healthMany of us, including medical practitioners, think that if we are having monthly, regular periods, then our reproductive system is healthy. Dr. Jerilynn Prior believes we haven’t studied ovulation closely enough. She details her position in a series of newsletters from the Centre for Menstrual Cycle and Ovulation Research (CEMCOR). Dr. Prior estimates that, among regularly menstruating women whose cycles have been normal for 10-30 years after menarche (one’s first period), one third do not ovulate. She suggests that ovulation is “a missing link in preventing osteoporosis, heart disease and breast cancer.”

Let’s Start at the Beginning

Let’s refresh our memories with a little physiology review. Ovulation is the release of an egg from an ovary. Once the egg leaves the ovary, the corpus luteum (a temporary endocrine gland) forms in the ovary and begins to produce progesterone. The egg travels down the fallopian tube to the uterus where it can be fertilized by sperm. If fertilization does not occur, the egg is swept from the uterus along with the thickened lining of the uterus during a woman’s monthly period, also known as menstruation.

The release of the egg at mid-cycle and the formation of the corpus luteum are necessary for the abundant production and release of progesterone, which is the hallmark of the second half of the menstrual cycle known as the luteal phase.

As a young girl reaches menarche, estrogen influences her body. Breasts start to develop and body fat is redistributed, rounding the body’s contours gradually into a “womanly” shape. However, ovulation doesn’t start immediately and therefore, neither does the release of progesterone. It could be as long as a year before ovulation actually starts, and only after ten years does ovulation occur 95% of the time. One indicator that ovulation has begun, Dr. Prior explains, is the size of the areola around the nipple. When ovulation starts the areola becomes larger and darker.

Ovulation may be disturbed by stress, emotional upset, inadequate nutrition, and over-exercising without adequate food intake. Dr. Prior writes that there are two types of ovarian disturbances. One is an anovulatory cycle when no egg is released by the ovary. The other is luteal phase defect when an egg is released but there is insufficient progesterone produced by the corpus luteum in the ovary, leading to a shortened luteal phase. Both ovarian disturbances result in an inadequate production of progesterone.

Testing for Ovulation

No test actually “sees” the egg being released from the ovary, so medical practitioners have developed tests that use indirect methods to detect when ovulation has occurred.

  • One test requires a daily ultrasound of the ovaries to track the formation of the pre-ovulation cyst on the ovary and the eruption that occurs when an egg is released.
  • Another test involves taking a biopsy of uterine tissue, which can show cell proliferation caused by estrogen exposure and cells that have matured under the presence of progesterone.
  • Blood tests can verify that progesterone levels are rising to expected levels during the luteal phase.
  • Ovulation predictor kits, available online and at drug stores, test for a release of LH (luteinizing hormone) from the pituitary gland (a precursor to ovulation), but do not establish that ovulation has actually taken place.

In Dr. Prior’s studies, she documented the effectiveness of monitoring molimina to predict ovulation. Molimina is the set of symptoms that appear before the menstrual period that indicate ovulation has occurred. These symptoms include:

  • The onset of pain high up in the underarm region
  • Fluid retention
  • Mood sensitivity
  • Appetite increase

These symptoms may be mild and not reach the severity of PMS symptoms. Dr. Prior notes that nipple pain and general pain in the breast indicate high estrogen levels, but not necessarily ovulation. If a woman has no awareness of an oncoming period, ovulation has probably not taken place.

Another way to track ovulation is to monitor body temperatures first thing in the morning. The progesterone produced following ovulation acts on the hypothalamus and increases body temperature. Temperatures will be above average for 10-16 days if ovulation has occurred. To monitor body temperatures, use a digital thermometer to record readings every day. Add up all the temperatures for the month and divide by the number of days to get the average temperature, and then count how many days have been above average.

Ovulation and Our Health

Few researchers have tracked the effects of ovulation and its related hormones on the body over the course of a lifetime, but Dr. Prior shares findings from a number of studies addressing specific aspects of women’s health, as well as her conclusions from this information.

  • A recent study demonstrated that the greatest increases in bone density for young women don’t occur until about one year after menarche, when ovulation starts and progesterone is produced from the ovaries. Progesterone has been seen to be active at the bone building sites, the osteoblasts. On the other hand, menstrual cycles without ovulation, especially during the perimenopause years, may account for increased bone loss.
  • For many years, researchers have observed that both estrogen and progesterone can contribute to breast cell growth and proliferation. However, initial observations were usually only made over a day or two. After a few days in cell cultures, estrogen continues to stimulate cell growth, but progesterone contributes to breast cell maturation and differentiation. These mature cells are less prone to become cancerous in the presence of progesterone.
  • A common myth about heart disease is that it is the same disease in women as in men. For example, cholesterol levels in women do not appear to correlate with heart disease as they do in men, and taking a daily aspirin for preventing a heart attack may work for men but not for women. It was thought that estrogen prevented heart disease because HDL levels were increased with adequate estrogen levels, but repeated studies demonstrate that this is a myth.
  • Progesterone may affect heart health in a number of ways. It may decrease blood pressure, and it doesn’t appear to be associated with clot formation. While restriction of blood flow in the arteries can increase heart attack risk, progesterone may reduce this risk by increasing blood flow as well as or better than estrogen. Progesterone also appears to help prevent insulin resistance and obesity, two important cardiovascular risk factors. Cycles without ovulation and progesterone production, therefore, could be considered a risk for heart disease.

What can we do to support ovulation and progesterone production? Reducing stress and a healthy, balanced diet are good first steps. In order to detect if ovulation is occurring, monitor pre-ovulatory days for symptoms, chart morning temperatures, or use ovulation predictor kits. If ovulation isn’t occurring, progesterone levels may become depleted. In this case, progesterone may be supplemented to achieve optimal levels. Dr. Prior recommends 300 mg of progesterone used in a cyclic fashion (use for two weeks, stop for two weeks) to restore progesterone lost from lack of ovulation.

As it turns out, we can’t assume everything is well just because we are having a monthly period. Much is going on behind the scenes. However, as stated above, we can pay attention to what our body is trying to tell us. By listening to our body, we can keep our body strong and healthy for years to come.

Ovulation is Crucial 2017-12-12T15:35:51+00:00

Skin Deep Look At Hormones

Skin Deep Look At Hormones

Written by Michelle Violi, PharmD – Women’s International Pharmacy

There is no doubt that hormones affect the skin, but do different hormones affect the skin differently? Let’s take a closer look.


  • Estrogen appears to affect the skin and its appearance in a number of ways: It supports collagen production, it maintains skin moisture by increasing certain skin components called mucopolysaccarides and hyaluronic acid, and it may assist in maintaining barrier function of the stratum corneum (the outermost layer of the skin).
  • A study using topical estriol 0.3% cream or estradiol 0.01% cream showed markedly improved elasticity and firmness of the skin as well as decreased wrinkle depth and pore sizes in both groups.
  • A study using topical or oral estradiol with or without progesterone showed improvement in skin surface lipids, epidermal skin hydration, skin elasticity, and skin thickness after six months.


  • A study using topical progesterone 2% cream showed an increase of elastic skin properties and firmness, and a decrease in wrinkle number and depth.


  • Thyroid affects the skin through a number of different mechanisms. Thyroid hormones have a direct action on the skin itself, the skin can manifest symptoms based on thyroid hormone actions (or lack thereof) on other tissues, and the thyroid and skin can both be affected by the body’s autoimmune response.
  • Skin-related symptoms of low thyroid function include:
    • Rough, thin, scaly skin
    • Edema, or swelling of the skin
    • Puffiness of hands, face and eyelids
    • Pale skin
    • Cold skin
    • Dry skin
    • Decreased sweating
    • Rash of purple spots
  • Skin-related symptoms of excess thyroid function include:
    • Smooth, thin skin
    • Warm skin
    • Increased sweating
    • Reddening of skin
  • Skin-related symptoms of autoimmune related thyroid disorders such as Graves’ disease or Hashimoto’s thyroiditis include:
    • Eczema
    • Hives
    • Vitiligo, loss of skin pigment


  • Stress conditions can increase cortisol production in the body and contribute to immune system dysfunction and inflammation. This can lead to slowed wound healing, psoriasis exacerbation, acne flares, and atopic dermatitis (often associated with eczema and itch).
  • Increased cortisol and other adrenal related hormones can also impact skin aging by a variety of different mechanisms, such as DNA damage.


  • Androgens like testosterone affect a number of different functions of the skin. Examples include growth of the sebaceous glands, which are the glands that produce the waxy, oily substance known as sebum, as well as keeping the skin ‘s barrier intact and wound healing.
  • An excess of testosterone or a testosterone imbalance relative to the other sex hormones in the body can increase the production of sebum in the skin, which can lead to acne.


  • Melatonin regulates sleep and wakefulness in the body. Some use melatonin supplements to help them sleep. A study showed poor quality sleepers to have increased signs of skin aging including fine lines, uneven pigmentation and reduced elasticity.
  • A study using topical melatonin combined with vitamins E and C showed protection to the skin from the effects of the sun.

Hormones play a significant role in the health and function of the skin and the skin is greatly affected by hormones in the body. Interestingly, recent studies have shown the skin itself can also produce hormones. Dehydroepiandrosterone (DHEA) and androstenedione are converted in the skin to testosterone and 5 alpha dihydrotestosterone (5 alpha DHT). Scientists hope this will further our understanding of how the skin and its hormones affect the health and wellness of the entire human body.

  • Safer JD. Thyroid hormone action on skin. Dermatoendocrinol. 2011;3(3):211-15. www.landesbioscience.com. Accessed February 13, 2017.
  • Zouboulis CC, Degitz K. Androgen action on human skin – from basic research to clinical significance. Exp Dermatol. 2004;13(suppl):4:5-10. doi:10.1111/j.1600-0625.2004.00255.x. https://search.proquest.com/docview/304607160
  • Zouboulis CC. The skin as an endocrine organ. Dermatoendrocrinol. 2009;1(5):250-52. www.landesbioscience.com. Accessed February 13, 2017. https://lpi.oregonstate.edu/mic/food-beverages/cruciferous-vegetables
  • Chen Y, Lyga J. Brain-Skin Connection: Stress, Inflammation and Skin Aging. Curr Drug Targets Inflamm Allergy. 2014;13(3):177-90.
  • Holzer G, et al. Effects and side-effects of 2% progesterone cream on the skin of peri- and postmenopausal women: results from a double-blind, vehicle-controlled, randomized study. Brit J Dermatol. 2005;153(3):626-34. doi:10.111/j.1365-2133.2005.06685.x.
  • Schmidt JB, et al. Treatment of skin aging with topical estrogens. Int J Dermatol. 1996;35(9):669-74. https://www.ncbi.nlm.nih.gov/pubmed/8876303. Accessed February 10, 2017.
  • Shah MG, Maibach HI. Estrogen and skin: An overview. Am J Clin Dermatol. 2001;2(3):143-50. https://www.ncbi.nlm.nih.gov/pubmed/11705091. Accessed February 10, 2017.
  • Sator PG, et al. The influence of hormone replacement therapy on skin ageing: a pilot study. Maturitas. 2001;39(1):43-55. https://www.ncbi.nlm.nih.gov/pubmed/11451620. Accessed February 10, 2017.
  • Dreher F, et al. Topical melatonin in combination with vitamins E and C protects skin from ultraviolet-induced erythema: a human study in vivo. Brit J Dermatol. 1998;139:332-39.
Skin Deep Look At Hormones 2017-11-29T14:44:39+00:00

The Cortisol Connection

The Cortisol Connection:

How Adrenal Hormones Affect the Health of Pets (And Their Owners)

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy

cortisol connection pets

Steroids are a class of medications that are used to treat inflammation, allergic reactions and pain in pets. Synthetic steroids, such as prednisone, dexamethasone, prednisolone, and triamcinolone are already widely used in veterinarian practices. Synthetic steroids have a long list of side effects and may be dangerous to use for a prolonged period of time.

Dr. Al Plechner devised another treatment approach. He used hydrocortisone, a steroid hormone bioidentical to the cortisol produced in the body, to supplement the pets’cortisol levels. His book, Endocrine-Immune Mechanisms in Animals and Human Health Implications, describes this series of events that may lead to many chronic illness symptoms and shortened lives:

Cortisol disruption can occur in a number of different ways. The adrenal glands may not produce enough cortisol. Or, cortisol may be produced, but be unavailable for use because it is bound tightly to proteins. Or, variations in enzymes or receptors may lead to less actual cortisol activity.

When the pituitary gland senses cortisol disruption, it compensates by sending more and more stimulation to the adrenal glands. If cortisol activity remains uncorrected, the pituitary signals continue and stimulate estrogen and androgen production from the adrenal glands. Dr. Plechner is convinced these estrogens and androgens come from the adrenal glands rather than the ovaries or testes because 90% of the animals he treats are spayed or neutered.

An increase in adrenal estrogen production triggers the body to produce binding proteins. Like cortisol, thyroid hormones can be made unavailable for use by the body when bound to proteins. Usual lab tests may show normal thyroid levels because the thyroid hormones are present, but they are unavailable for use by the body. Cholesterol and triglycerides also may be high.

Symptoms in pets related to low thyroid function include:

  • excess sleepiness
  • sluggishness
  • excess pigment in the in nose, pads of the feet, and abdomen.

Ultimately, the immune system may be disrupted. Testing, performed by Dr. Plechner, revealed that many important immune proteins were low in pets with the imbalances described above. He theorized that the high levels of adrenal estrogen were responsible for these changes in the immune system along with the lack of cortisol activity.

He found supplementing with hydrocortisone made up for the lack of adrenal activity and, within a very short period of time, total estrogen levels dropped and immune proteins improved. More importantly, the health of the dog or cat was restored.

Interestingly, adequate thyroid hormones are needed to help break down cortisol in the body. Many dogs needed thyroid supplementation in addition to hydrocortisone to restore their health. Cats did not generally display the same thyroid deficiency problems, and so fewer needed thyroid.

Dr. Plechner writes that the area of the adrenal gland which produces cortisol is the most sensitive to assaults by chemicals, toxins, and continued stress. Inbreeding of pet animals has led to serious weaknesses with the adrenal production and activity of cortisol. Once cortisol activity has declined, serious impairment of the immune system likely follows. Dr. Plechner has linked the following conditions to this imbalance: infertility, endometriosis, cystic ovaries, heavy bleeding during menstruation, malabsorption and digestive disorders, allergies, lung problems, urinary tract problems, liver dysfunction, behavior changes, epilepsy, obesity, deadly infections, periodontitis, vaccinosis, autoimmunity and cancer.

Dr. Plechner believes that this situation also occurs in humans. He proposes that the work presented by Dr. William Jefferies in “Safe Uses of Cortisol” illustrates the human equivalent. Dr. Jeffries also found the use of low doses of supplemental hydrocortisone to be helpful for a large spectrum of disorders.

It is amazing to think that this cascade of hormone and immune dysfunctions could be behind so many different maladies. On the positive side, laboratory testing of cortisol, thyroid, and total estrogens can easily confirm this imbalance. Although it is not yet a standard practice, treatment with hydrocortisone is inexpensive and, according to Dr. Plechner, extremely effective and even life-saving. If you or your pet suffer from any of the conditions mentioned in this article, it may be worthwhile to discuss testing and hydrocortisone with your veterinarian and/or personal health care practitioner.

Additional Resources:

Book Review – Paleo Dog

The Cortisol Connection 2017-12-15T11:23:41+00:00

Healthy Sleep and Rest

Healthy Sleep and Rest

Written by Gina Besteman, RPh, & Michelle Violi, PharmD – Women’s International Pharmacy

One of the more common symptoms of peri-menopause and menopause that patients complain of is difficulty sleeping. There is a significant amount of research showing how hormones affect healthy sleep. healthy sleep

Progesterone affects GABA receptors which are responsible for non-REM sleep, the deepest of the sleep stages. Progesterone also affects breathing. It’s been shown to be a respiratory stimulant and has been used to treat mild obstructive sleep apnea.

The role of estrogen in sleep appears to be more complicated than that of progesterone. Estrogen is involved in breaking down norepinephrine, serotonin, and acetylcholine in the body. It has also been shown to decrease the amount of time it takes to fall asleep, decrease the number of awakenings after sleep occurs, and increase total sleep time. Low estrogen levels may lead to hot flashes, which can also affect sleep.

Cortisol is a hormone produced by the adrenal glands in response to stress. It normally peaks in the early morning followed by a slow decline throughout the day and night. However, chronic stress can alter healthy cortisol production and lead to sleep problems if cortisol is low in the morning and increased in the evening and at night.

Melatonin is a hormone produced by the pineal gland in the brain that regulates sleep and wakefulness. Normally, melatonin levels begin to increase in the mid to late evening, remain elevated throughout the night and drop in the morning. In general, melatonin levels decrease with age and melatonin production can be shut off by bright light. If melatonin levels are disrupted, sleep may be disrupted as well.

In addition to hormones, sleep can be affected by a number of external factors. It is important to maintain proper sleep hygiene as follows:

  • Avoid napping during the day
  • Avoid stimulants such as caffeine, nicotine, and alcohol too close to bedtime
  • Exercise can promote good sleep, but avoid vigorous exercise too close to bedtime
  • Food can be disruptive right before sleep
  • Ensure adequate exposure to natural light during the day
  • Establish a regular relaxing bedtime routine
  • Associate your bed with sleep
  • Make sure that the sleep environment is pleasant and relaxing and free from light pollution, e.g., lighted alarm clock faces, street lights through open windows, and cell phones/tablet devices
  • Eichling PS. Evaluating and Treating Menopausal Sleep Problems. Menopause Management. Sept/Oct 2002.
Healthy Sleep and Rest 2017-12-14T15:01:55+00:00

Holiday Stress and Hormones

Holiday Stress and Hormones

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy

Dr. Penny Kendall-Reed spoke at the Integrative Health Symposium conference in October, 2015, highlighting the complexity of how stress affects hormone activity. holiday stress

Research has sought to identify the unique characteristics of hormones for decades.  This is difficult, however, because hormones do not act in a vacuum, but have distinct relationships with each other.

Introducing the Hypothalamus, Pituitary Gland and the Adrenal Glands
One of the more complicated hormone relationships involves the HPA axis. The HPA axis is a set of interactions and signals that exist between the Hypothalamus, the Pituitary gland and the Adrenal glands. This relationship is an indispensable part of our existence.

The hypothalamus is a very tiny area in the brain with an enormous number of functions. Some of these functions include the regulation of body temperature, hunger, attachment behaviors, thirst, fatigue, sleep, and circadian rhythms. The hypothalamus produces a number of hormones which directly stimulate the pituitary gland.

The pituitary gland is also located in the brain and produces hormones that play a role in regulating the thyroid gland, ovaries, testes, and adrenal glands among other things.

The adrenal glands are located above each kidney and produce hormones that help the body control blood sugar, burn protein and fat, react to stressors like a major illness or injury, and regulate blood pressure.

An example of HPA axis activity (i.e., the interaction between these three glands) is as follows: In response to stress, the hypothalamus produces corticotropic releasing hormone (CRH) which signals the pituitary gland to release adrenocorticotropic hormone (ACTH). ACTH then signals the adrenal glands to produce stress hormones cortisol, epinephrine, and norepinephrine to be used by the body to respond to the stressor. Uniquely, women experience more stimulation to the HPA axis under conditions of stress than men do.

The HPA Axis is Self-Regulating
Not only does the HPA axis work to produce hormones to respond to stress, it also regulates itself so the body stops producing stress hormones when they’re no longer needed. When cortisol is released by the adrenal glands into the blood, receptors in both the hypothalamus and the pituitary gland are able to detect this rise in cortisol. The activation of these receptors turns down the production of CRH and ACTH ultimately resulting in a decrease in the production of cortisol. Ideally, the interaction between the hypothalamus, the pituitary gland, and the adrenal glands creates an environment of stability and consistency using these feedback loops.

Sex Hormones
The hypothalamus and the pituitary gland also play a role in regulating the production of sex hormones. The hypothalamus produces gonadotropin releasing hormones (GnRH) which stimulate the pituitary gland to produce luteinizing hormone (LH) and follicle stimulating hormone (FSH) which in turn stimulate the production of estrogens, progesterone, and testosterone by the ovaries and testes. The hypothalamus and the pituitary gland monitor and regulate the ebb and flow of sex hormones with a feedback loop similar to the one used by the HPA axis.

Failure of the HPA Axis Feedback Loop
If the body believes it is under constant stress, the hypothalamus and pituitary gland continue to produce CRH and ACTH to stimulate more and more cortisol production. Eventually, however, the system starts to malfunction. Chronic high cortisol levels damage the production of GnRH from the hypothalamus and, as a double whammy, increase the production of a gonadotropin inhibiting hormone (GnIH), which disturbs the production of sex hormones from the ovaries and testes.

What Happens Next?
Infertility is a significant consequence of the disruption of the delicate hormone symphony. Continued, elevated levels of cortisol are thought to be a prime cause of infertility:

  • Stress may increase the production of prolactin from the pituitary gland which can inhibit ovulation.
  • Cortisol increases inflammation in the uterus which may cause cramping, spasms, and even miscarriage.
  • Increased spasms may cause damage to the egg in the fallopian tube.
  • Disruptions of the HPA axis are thought to be an underlying cause of polycystic ovarian syndrome (PCOS), a condition associated with infertility in young women.

Weight gain is another potential consequence when the HPA axis is disrupted:

  • Ghrelin is a hormone produced in the stomach which contributes to the feeling of hunger. Once food is consumed, ghrelin production is turned off with some help from a neurotransmitter named dopamine. Cortisol can interfere with dopamine activity which may leave one feeling hungry even after eating.
  • Another hormone called leptin, which is produced in fat cells, inhibits food cravings and initiates fat burning. Cortisol can block the release of leptin. Fat deposited in the abdomen has 30% more cortisol receptors than the rest of the body’s fat, so the cortisol blocking effect on leptin release may be further enhanced in individuals with an excess of abdominal fat.
  • Cortisol amps up insulin release in response to grains and fruits possibly leading to increased food cravings.

What Can We Do to Reverse This?
The most obvious step is to take measures to relieve chronic stress. This can include massage, yoga, meditation, deep breathing, exercise and diet. Natural supplements can also be used. Lactium, a peptide isolated from milk may be used to re-sensitize the hypothalamus to cortisol and re-establish the feedback loop. Herbs like magnolia, ashwaganda, schizandra can moderate cortisol production. Theanine from green tea and the amino acid GABA can also mitigate stress reactions. Judicious use of bioidentical hormones may also help break this cycle of dysfunction.

The takeaway point from Dr. Kendall-Reed’s presentation is that high levels of stress and persistent high levels of cortisol affect the very intricate and complicated balance of many hormones. Learning to manage stress with life style, nutrients, hormones and perception may help restore more balanced functioning to many of the body’s systems.

  • Kendall-Reed P. Lecture presented at: Integrative Health Symposium; October 2015.
Holiday Stress and Hormones 2017-12-08T14:54:49+00:00

Hormones on Our Minds and Nerves

Hormones on Our Minds and Nerves

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy

George Orwell’s novel 1984 predicted a society with language controls and “double speak.” It astonishes me how accurate these predictions have been in the field of medicine, as evidenced by the fact that various medical establishments meet regularly to decide how their members ought to think about issues such as hormones.

Some say that, without sufficient evidence to the contrary, all estrogens are alike and all progesterone/progestins are alike. Even basic science courses, going back decades, teach that very small differences in shape and size between molecules can have significant differences in their effects on the body. Recently, the KEEPS study opened the door to the idea that perhaps all estrogens are NOT alike. (See KEEPS Study for more info.)

One of the most enduring (and preposterous) pronouncements has been that women without a uterus do not need progesterone. The idea is that the hormone progesterone has a single function, which is to slough off accumulated tissue in the uterus and in doing so, preventing uterine cancer, and that it has no other effects on the body. In a perverse way, this pronouncement has saved numerous women from the effects of progestins (altered progesterone molecules) such as medroxyprogesterone, which was linked in the Women’s Health Initiative Study with an increase in breast cancer risk.

This type of limited thinking perseveres, potentially leading to serious deficits in medical care. Over 40 years ago, Dr. Katharina Dalton wrote that women without a uterus most likely had surgery to remove their uterus because of a long-standing deficit of progesterone, and actually needed much more progesterone than women reaching a natural menopause.

One area of research that is currently opening minds to the potential of hormones focuses on “neurosteroids,” which are hormones produced by nerve cells in the brain, spinal cord and peripheral nervous system, independently of hormone production elsewhere in the body. In essence, this research indicates that the “sex” hormones we commonly identify as being produced by the ovaries, testes, and adrenal glands (such as the estrogens, progesterone and its derivatives, DHEA, testosterone, pregnenolone, and others) are so important to neural function that they are also independently produced by neural tissue.

The neural tissue responds to the hormones circulating in the blood stream and to the neurosteroids (i.e., the hormones produced locally by the nerves themselves). The local neurosteroid production allows for higher concentrations of hormones when and where they are needed, and these concentrations can be 20 to 50 times the level circulating in the blood stream. Different areas of the brain, or different nerve cells, may produce or concentrate different hormones. Some hormones may also trigger opposing activities, depending on their concentrations.

The interplay of neurosteroids is extremely complicated, and the science is just getting started. What is equally exciting is that our minds are being opened to the possibilities that the so-called “sex” hormones might now also prove useful for treating neurodegenerative diseases!

Steroidal hormones are believed to help heal damaged neural tissue. For example, in the disease ALS (amyotrophic lateral sclerosis), it has been hypothesized that motor neurons may be affected by a deficiency of receptors for testosterone. Estrogens can make it worse by causing neuronal excitement. Progesterone may help repair the neurons by repairing the myelin sheath that protects them. Notably, patients with ALS typically have low progesterone levels.

With Alzheimer’s disease, changes occur in brain cells that can be linked to hormone levels, according to Dr. Ray Peat. Of prime importance is the ability of the mitochondria (i.e., the part of a cell responsible for energy production) to use oxygen. The enzyme needed for oxygen uptake is dependent upon sufficient thyroid hormones, and antagonized by the presence of estrogen, iron and toxins. A low progesterone level, relative to estrogen, results in increased levels of LH and FSH (pituitary hormones associated with menopause, when elevated). Both LH and FSH are themselves very inflammatory, and may be balanced by DHEA and testosterone, and even more so by progesterone.

Dr. Dalton found that progesterone helped women eliminate premenstrual epileptic seizures. Neurosteroid scientists have demonstrated the effectiveness of both progesterone and its metabolite allopregnanolone in preventing convulsions.

As this research continues, we may discover that vision and hearing could be improved by ensuring the healthy functioning of the nerves involved. Cognition, memory, and mood may be improved with a healthy nervous system. Mental diseases, such as schizophrenia, may be curtailed with neurosteroid hormones. And we may find that one of the brightest neurosteroid stars, progesterone, is not just for the uterus.

  • Dalton K. Once a Month: Understanding and Treating PMS. Hunter House Inc.; Alameda, CA; 1999.
  • Peat R. Demystifying Dementia, Protective Progesterone. Ray Peat’s Newsletter, Jan 2013.
  • King SR. Neurosteroids and the Nervous System. SpringerBriefs in Neuroscience; Springer Science+Business Media; New York, NY; 2013.
  • Baulieu E, Schumacher M. Progesterone as a neuroactive neurosteroid with special reference to the effect of progesterone on myelination. Steroids; 65 (2000) 605-612.
  • Schumacher M, et al. Novel Perspectives for Progesterone in Hormone Replacement Therapy with Special Reference to the Nervous System. Endocrine Reviews; 28 (4) 387-439; 2007.
Hormones on Our Minds and Nerves 2017-12-14T12:54:27+00:00

Andropause: What You Should Know about Male Menopause


What You Should Know About Male Menopause

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy

Almost everyone is familiar with the term menopause, which refers to the end of a woman’s reproductive years. What some people don’t know is that men also go through a similar transition, known as andropause or male menopause, during their later years. In both cases, the transition is associated with hormone deficiencies and tends to coincide with other age-related declines. Fortunately, appropriate hormone treatment generally provides symptom relief, and also tends to delay other age-related illnesses or conditions.


Andropause is not considered to be a disease, nor is it the same as the “midlife crisis” some men exhibit as they age. Most midlife crises occur 10 to 20 years before andropause and may be indicative of the beginning of the decline, similar to symptoms of pre- or perimenopause in women.

The existence of andropause has been debated for years, but has recently gained recognition as a very real physiological state of hormone deficiency. Yet there is still controversy over an exact definition. Some practitioners define andropause as the inability to have a penile erection; others associate it with a marked decline in hormone levels. What most agree on is that andropause is the result of a very gradual, age-related decline in hormones such as testosterone, DHEA, and others.

Between the ages of 25 and 50, men’s testosterone levels tend to decrease by approximately 10% per decade, yielding over a 50% reduction by the time they reach their 60s. Because it is such a slow decline and men’s responses to it vary widely, andropause is difficult to detect. The fact that men generally do not discuss symptoms as readily as women, also makes it more difficult to diagnose.

During this period of testosterone decline, men’s estrogen hormone levels tend to increase by almost 50%, drastically altering their hormone balance. This change in the ratio may help explain why many men begin to feel more family-oriented and nurturing as they age.

Factors that accelerate the decline of hormones such as testosterone and DHEA include:

• excess weight, especially abdominal obesity
• illness, disease, or other stressful events
• tobacco consumption
• drug or alcohol abuse
• depression or mental illness
• reduced sexual activity

Common Symptoms

Similar to menopause, the effects of andropause are not uniform and each man’s response to it is unique. That said, there are commonly reported symptoms, many of which are considered part of the “normal” aging process (see chart on next page), but which are also accelerated by a testosterone deficiency.

Symptoms of testosterone deficiency tend to fall into one of four categories: physical, cardiovascular, mental, or sexual, with some of them overlapping. For example, feeling too weak or tired to engage in sex could be related to impaired cardiovascular health, feelings of insecurity, and decreased libido, all of which may be related to a testosterone deficiency.

Symptoms Associated with Andropause

• Balding head
• Reduced body hair, especially armpits and genital area
• Decreased muscle mass, with increased body fat
• Reduced strength and stamina
• Feeling weak or tired
• Decreased testicle size
• Enlarged prostate
• Urinary discomfort and/or difficulties

• Increased abdominal fat, increasing risk of heart attack
• Increased insulin, cholesterol, and triglyceride levels
• Elevated blood pressure
• Diminished coronary artery elasticity
• Weakening of the heart muscle

• Moodiness, irritability, insecurity
• Inner unrest
• Lack of concentration
• Memory failures
• Reduced intellect and critical thinking

• Decreased sex drive and arousal
• Reduced organ sensitivity or pleasure
• Fewer orgasms
• Erectile dysfunction

One of the most troubling symptoms men encounter as they age is an enlarged prostate. The prostate gland goes through a second growth spurt as men reach their 40s, 50s, or 60s, often resulting in benign prostatic hyperplasia (BPH). As the prostate grows, it pushes on the bladder and urethra, causing mild to severe urinary discomforts such as increased frequency of urination, especially at night; difficulty initiating urination; decreased urinary force; and the sensation of a full bladder, even after urinating.

Current medical research indicates that low testosterone levels may be associated with BPH, especially when coupled with elevated estrogen hormone levels.

Treatment Options

With increasing life spans, the number of years that a man might live with hormone deficiencies also increases. The earlier that a hormone imbalance is detected and treated, the better. Hormone supplements can provide symptom relief while delaying other age related declines.

Because andropause has not been studied as much as menopause, some healthcare practitioners may not suggest hormone treatment unless you ask about it. Some practitioners may also maintain a lingering concern over testosterone supplements, primarily due to past abuse by athletes who injected synthetic steroids to build muscle mass.

The testosterone treatments available today such as oral capsules, sublingual lozenges, patches, creams, and gels can be quite effective and easy to use, with minimal side effects. The benefits they offer may include:

• improved energy and overall well-being
• increased strength and stamina
• enhanced mood and self-esteem
• improved concentration and memory
• enhanced libido and sexual function.

If you decide to pursue hormone therapy, be aware of the differences between conventional hormone therapy and natural hormone supplements. Natural hormones are those that are bio-chemically identical to the hormones found in your body. As such, their effects in the body are the same as the effects of the hormones they are supplementing.

Hormones in some conventional hormone therapy are not identical to human hormones. In addition, most conventional hormone therapies come in just a few standardized doses, which may or may not include the optimum dose for your needs. Bioidentical hormone supplements are often custom compounded, which allows for specific dosing and potency, and tailoring each prescription for each individual’s needs.

With any hormone treatment, it is important to work with your healthcare practitioner to maintain the proper hormone balance. This is especially true if you also use other supplements or herbs, as they may interact with your medications, including hormone treatments.

Andropause: What You Should Know about Male Menopause 2017-12-14T12:36:09+00:00

Treatment Options for Cervical Dysplasia

Treatment Options for Cervical Dysplasia

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy

Hearing the words “abnormal Pap smear” can trigger a gut-wrenching fear—and for good reason. Cervical cancer was the leading cause of death among women for many years. Today, it ranks only 13th among women in the US, yet many women continue to have “abnormal” Pap test results. What’s going on?

“Abnormal” Pap test results are now fairly common, and almost always due to the widespread human papillomavirus (HPV). There are many types of this virus, and it is so common that the American College of Obstetricians and Gynecologists states that “most women will be infected with it at some point during their lifetime,” and they may not even know it because there are typically no symptoms.

Cervical Dysplasia

HPV is the leading cause of cervical dysplasia, a catch-all term for abnormal cells in the cervix. Cervical dysplasia is a primary risk factor for cervical cancer, but it does not mean that cancer will develop. Fortunately, cervical cancer is slow-growing, usually taking years to develop, and its precursor, cervical dysplasia, is easily detected as part of routine Pap tests.

Atypical squamous cells of undetermined significance (ASCUS) is the most common abnormal Pap test result. It means exactly what is says: something unusual is present, which could be precancerous or not, and/or it could be cervical dysplasia or not. The typical recommendations are to repeat the Pap test in six months and “wait and see” if something develops.

Treatment Options

For those who are interested in a more proactive approach to managing their health, some naturopathic practitioners suggest there are safe and natural ways to treat (and perhaps even prevent) mild to moderate cervical dysplasia.

Drs. Tori Hudson, Marianne Marchese, and others have had success treating cervical dysplasia with supplements including folic acid, indole-3-carbinol (I3C), vitamins A and C, antioxidants such as green tea and carotenes, as well as herbal remedies. Natural treatment formulations include oral formulations and vaginal suppositories.

Green tea extract, also known as epigallocatechin-3-gallate (EGCG), shows promising results as one of the more effective natural treatment options. In a study comparing the application of different EGCG formulations to subjects with cervical dysplasia, close to 70% of the subjects demonstrated an improvement in their condition, as opposed to only 10% in the control group. Among the different formulations, there was slightly more success using ointment alone, or ointment and capsules, than capsules alone. This study bodes well for the vaginal use of an ointment or suppository containing green tea extract as an effective treatment for cervical dysplasia.

With any treatment—including surgical treatments—cervical dysplasia can return. “Addressing the cause is key to treating the disease,” warns Dr. Marchese. Nutritional and hormone deficiencies affecting the immune system should also be addressed as part of a treatment plan.


Education regarding how HPV is transmitted, as well as the risk factors associated with both cervical dysplasia and cervical cancer, is critical to prevention.

Practicing safe sex is now more important than ever. Anyone of any age who is sexually active can be exposed to HPV. It is transmitted by skin-to-skin contact, usually during vaginal, anal, or oral sex. Not everyone who is exposed to the cell-changing types of HPV will exhibit dysplasia or know they have been exposed (especially males).

Quitting smoking can significantly reduce the risk of cervical dysplasia. Smokers are two to three times more likely to develop cervical dysplasia for several reasons:

  • Nicotine concentrates in the cervical glands
  • Smoking reduces the levels of ascorbic acid, which changes the pH balance of the cervix
  • Smoking alters immune system function

Reducing stress or finding ways to manage unavoidable stress may help reduce the development of dysplasia. Dr. Hudson found that “life stressors with negative impacts over the previous 6 months showed a direct, positive association with the level of dysplasia.”

Finally, maintaining a healthy immune system is obviously an extremely important aspect of prevention, as well as treatment.

  • Hudson T. Preventing and Treating Cervical Dysplasia: A Natural Medicine Perspective. Altern Complement Ther. 2001;7(1): 15-20.
  • Marchese M. Management of Cervical Dysplasia and Human Papillomavirus. American Association of Naturopathic Physicians; January 2013; https://www.naturopathic.org/article_content.asp?article=788.
  • Swanick S, Windstar-Hamlin K, Zwickey H. An alternative treatment for cervical intraepithelial neoplasia II, III. Integr Cancer Ther. 2009 Jun;8(2): 164-7. doi: 10.1177/1534735409335504.
  • Zou C, et al. Green tea compound in chemoprevention of cervical cancer. Int J Gynecol Cancer. 2010 May;20(4):617-24. doi: 10.1111/IGC.0b013e3181c7ca5c.
Treatment Options for Cervical Dysplasia 2017-10-17T12:19:09+00:00

A New Organ Has Been Identified: The Human Microbiome

A New Organ Has Been Identified: The Human Microbiome

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy

That’s right. It has been there all along, but we are just now getting around to noticing it. This organ weighs about three pounds and by weight, it is the largest organ in the human body. The organ is a collection of microbes or single celled organisms that live on and in your body. It has been named the human microbiome.

Our bodies are made up of about 10 trillion cells, but we host approximately 100 trillion microbe cells. To put a trillion in perspective, if we were to live for one trillion seconds, our life span would exceed 32,000 years. Based on the math, we are only 10% human!

It was surprising to the scientific community when the Human Genome Project was completely finished earlier than anyone predicted. It turns out that human beings only have about 20,000 genes. We have significantly fewer genes than rice or corn! However, we also carry and use two to twenty million genes from the vast number of microbes we host. If we compare the number of human genes to microbe genes rather than the number of human to microbe cells in our body, we are 99% microbe!

In an effort to identify the microbes living on and in the human body, the Human Microbiome Project was begun in 2008. It was a massive undertaking funded by the National Institute of Health (NIH) to the tune of 170 million dollars. More than 200 scientists worked on the project. The Human Microbiome Project continues to generate significant scientific findings to this day. Some examples include new technologies that sequence genes and computer programs which can handle vast amounts of data. These discoveries are opening up very exciting new areas of research.

Our human microbiome makes us more individually unique than our genetic composition. Genetically we are 99% identical to other human beings, but we only share about 10% with other human microbiomes. Even genetically identical twins do not share the same microbiome.

Since the time of Louis Pasteur, we have been operating on the “germ theory of disease.” This philosophy states that diseases are caused by microorganisms. One might assume that we are hapless victims of microbial assaults and to save ourselves we must use antiseptics or antibiotics to stem the attack. The latest findings of the Human Microbiome Project cause one to think twice about this assumption.

Normally, we live in harmony with these vast numbers of microbes. In fact, a healthy microbiome aids us in some essential life processes such as digestion, the integrity of our immune systems and even our behavior. However, many different things can cause changes in the composition of an individual’s microbiome. Diet, drugs, birth order, age, sexual partners and especially antibiotics are just a few examples. An altered or weakened human microbiome has been linked to diseases such as obesity, arthritis, autism, and depression.

The human microbiome also plays a role in hormone production and regulation in the body. For example, an organism called Clostridium scindens, which resides in the gastrointestinal tract, has been identified as capable of transforming cortisol type hormones to testosterone and other androgens. Surprisingly, our sex glands are not the only source of testosterone in our bodies! The genes of some bacteria in the gut are able to produce estrobolome, an enzyme which helps metabolize estrogens. A disordered microbiome in the digestive tract could be the underlying cause of estrogen dominance producing symptoms of infertility, PMS, heavy bleeding, cramps, polycystic ovary disease and more

Additionally, an overgrowth of yeast and related organisms in the microbiome has many documented effects on various hormones. Request a yeast information packet which contains a detailed chart of specific organisms and their impact on hormone balance.

Since so many different things can alter the microbiome, research is focusing on how to repair a damaged microbiome system. For example, scientists have found altering the microbiome normalizes the weight of obese mice. We have also seen amazing results with procedures called fecal transfers where the microbiome of a healthy person is essentially implanted into the body of a sick person.

We have long been using probiotics in the forms of specific cultures or in fermented foods. We also know about the use of substances which we call prebiotics such as inulin or fructo-oligosaccharides (FOS) that can nurture the growth of certain species of microbes. We are just now beginning to understand which species of microbes need to be re-established and how to reintroduce these specific strains with supplementation. For the consumer, the marketplace for probiotics can be confusing and frustrating. There may be very helpful probiotic strains available, but we still lack the knowledge of which probiotic strain we should choose for each particular condition.

While the science is still evolving, there is a lot we can do in the meantime. We can avoid the frivolous use of antibiotics and avoid eating antibiotic treated meats. We can carefully consider the need for certain medication before using them. Drugs like oral contraceptives may damage the microbiome. We can clean up our diet and avoid dairy, sugar and gluten which can adversely affect the microbiome. We can eat fermented foods like sauerkraut, kimchi, kombucha, and live culture yogurt daily. We can add probiotics and prebiotics to our daily regimen. Because the science has not caught up yet, try a variety of products to determine which might have the best effect for you. We are clearly entering an exciting new world of understanding how we, as human beings, interact with the invisible yet powerful world of microbes.

A New Organ Has Been Identified: The Human Microbiome 2017-12-12T15:15:30+00:00

Hormones and Chronic Lyme Disease

Hormones and Chronic Lyme Disease

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy


As of 2013, the Centers for Disease Control and Prevention estimate that there are approximately 300,000 new cases of Lyme disease per year in the US, which is 10 times more than the number of cases officially reported. And there are potentially many more “victims” who have yet to discover that they have the disease because the symptoms can mimic other disorders, such as arthritis, chronic fatigue syndrome, fibromyalgia, multiple sclerosis, Parkinson’s, and Alzheimer’s disease.

An article entitled “Lyme, Neurotoxins and Hormonal Factors, an interview with Nancy Faass, MSW, MPH,” which appeared in the July 2014 edition of the Townsend Letter, offers further insight into the complexity of diagnosis and treatment. Wayne Anderson, ND, and Robert Gitlin, DO, were the experts interviewed for the article.

Chronic Lyme disease patients experience a myriad of complications that make it difficult to diagnose, much less treat and restore the patient to wellness. Lyme disease patients are likely to be struggling with a whole host of problems beyond the infection from the Borrelia bacteria from the tick bite, including but not limited to co-infections such as Babesia, Bartonella, Ehrlichia, and Mycoplasma, along with assaults from mold toxins, petrochemicals, and heavy metals.

Adding to the complexity, some of the symptoms associated with the Borrelia infection are the same as symptoms caused by hormone imbalance. Dr. Gitlin finds that the vast majority of his Lyme disease patients are in a state of adrenal depletion, which needs to be addressed before addressing other hormone depletions.

In patients with Lyme disease, the hypothalamus is affected by the neurotoxins produced by the infectious agents. The hypothalamus is the master gland that ultimately affects the production of thyroid hormones, as well as the sex and adrenal hormones, so supplementing hormones can help offset the deficiencies.

To make matters worse, when Lyme disease symptoms are present, hormone transitions may be more difficult. Dr. Anderson suggests that, if you are directing your patients with bioidentical hormone therapies and they are not responding, chances are good that this patient also has Lyme disease and should be evaluated further.

Low testosterone levels provide an opportunity for infections to take hold. Starting during perimenopause and continuing after menopause, women get about half of their testosterone from the conversion of adrenal DHEA, as opposed to only about 10% in men. Consequently, menopausal women with Lyme disease will suffer even more than men with this disease.

The sex and adrenal hormones tend to have anti-inflammatory actions, so the decline of these hormones in all Lyme disease patients is even more critical, and some patients will present with chronic pain. Dr. Anderson will treat more aggressively with hormone therapies, in order to take advantage of the anti-inflammatory effects the hormones provide in these situations.

Progesterone and pregnenolone are both adrenal hormones, and are precursors to creating more cortisol and DHEA. Because the chronic stress of Lyme-related infections deplete these hormones, supplementing progesterone, pregnenolone, and DHEA can help.

Some patients with Lyme disease present with liver and/or gall bladder tenderness. Dr. Gitlin observes that, because most hormones are metabolized in the liver, using hormones at this point is likely to fail, and patients will not tolerate the hormones. It would be more prudent to address the infection and other toxicities first.

Low levels of DHEA impair liver detoxification and the flow of bile from the gall bladder. (Bile is needed absorb fats from the diet, and structurally it is related to the sex and adrenal hormones.) As a result, the liver becomes even more congested with toxins. As evidence of this, low DHEA levels and subsequent poor detoxification are also associated with an increased risk of breast cancer.

In addition, magnesium, which is an essential element and necessary for hormone balance, becomes critically depleted in patients with Lyme disease. The presence of mercury, a toxic heavy metal, may also be found with Borrelia infections.

Thyroid optimization is another key in helping Lyme disease patients, but only after adrenal support has been added. Hashimoto’s disease tends to be the result of an inflamed gastrointestinal tract, but a Lyme disease infection may also be part of the problem. In fact, Dr. Gitlin has observed the presentation of Hashimoto’s disease, a low white blood cell count, and an increased bilirubin levels (Gilbert’s disease) pattern, which he thinks may be a hallmark of Lyme disease.

Understanding the impact of Lyme disease on hormones (and vice versa) can help create the perspective needed for successful treatment. Why do hormones not work as effectively in some patients? Why do some women suffer much more at menopause transitions? And why do women tend to be more symptomatic with hormone imbalances than men? Considering the possibility that Lyme disease may be present and addressing the dimensions noted may increase the chance of success.

Hormones and Chronic Lyme Disease 2017-10-17T12:27:01+00:00