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It’s All About Balance…

How Proper Hormone Balance Affects Women’s Health

Hormones comprise a delicately balanced system in the body. People with a healthy hormone balance tend to enjoy long, healthy, and productive lives, but long-term hormone imbalances may take their toll on myriad aspects of health. In women, one or more hormone imbalance may contribute to such common problems as:

  • all about balanceBreast health conditions, including cancer
  • Endometriosis
  • Heart disease
  • Infertility
  • Miscarriage
  • Mood disor­ders
  • Osteoporosis
  • Ovarian cysts
  • Perimenopausal difficulties
  • Premenstrual syndrome (PMS)

While the cessation of hormone production with age is a gradual process, the consequences are noticeable, and some women may find hormone supple­mentation is key to bringing their bodies back into balance.

The Role of Hormones

The body produces hormones primarily in various glands (such as the thyroid, adrenal, and pituitary glands) as well as in other organs and cells. Hormones circulate in the bloodstream, which distributes them to cells throughout the body. Re­ceptors within these cells are sensitive to particular hormones that cause them to react; the more hormones that are present in the cell or the more sensitized the receptors, the more intense the reaction.


Estrogens are some of the most powerful hormones in the human body. Almost all tissues have re­ceptors that make them responsive to estrogens. In women, estrogens help the urinary tract, breasts, skin, blood vessels, and uterus to stay toned and flexible. The total amount of estrogens significantly declines after menopause.

Three Major Estrogen Types

While the human body produces several types of estrogen, those commonly used in estrogen replacement therapy (ERT) include estrone (E1), estradiol (E2), and estriol (E3). In younger women, estrone is converted primarily from estradiol in the liver. After menopause, it is mainly produced in fat cells, where it is derived from testosterone.

Estrogens through a Woman’s Lifetime

Estrogen levels start to rise in girls before menarche, sometimes as early as eight years old, and continue to rise until they start menstruation, around the age of 11 or 12. The hypothalamus signals the pituitary to release hormones, which then signals the ovaries to produce more estrogen. It also starts the development of breasts and the growth of pubic hair and hair under the arms.

Most women be­gin to experience decline levels of estrogens and progesterone in their early 30s. With this decline, there is also a decrease in fertility. In their early 40s, most women’s hormone levels rapidly drop leading up to menopause; symptoms of these hormonal changes may include:

  • Dryer skin
  • Brittle hair
  • Sparser pubic and underarm hair
  • Loss of libido
  • Mood swings

Conjugated Estrogens

Conjugated estrogens, such as Premarin, are the most com­monly used form of estrogen replacement therapy (ERT) pre­scribed by healthcare providers. However, researchers do not know for sure if conjugated estrogens increase cancer risk, so practitioners may advise women against standard estrogen therapy if they have a fam­ily history of cancer. Other potential side ef­fects of estrogen include:

  • Vaginal bleeding
  • High blood pressure
  • Nausea
  • Vomiting
  • Headaches
  • Fluid retention
  • Impaired glucose tolerance

The Bioidentical Estrogens Alternative

Tri-estrogen, or Tri-est, is a com­bination formula of bioidentical estrone, estradiol, and estriol. Bi-estrogen usually contains only estradiol and estriol (with the understanding that estradiol rapidly converts to estrone, and estrone to estradiol). Patients may take either combination in a daily or cyclical schedule, depending on the recommendation of their practitioner.


Progesterone’s Role in the Female Reproductive System

Progesterone plays an important role in women’s reproductive health. In menstruating women, progesterone is produced by the ovaries. Progesterone supplementation often may be beneficial for women struggling with infertility or symptoms associated with the menstrual cycle, such as PMS or polycystic ovary syndrome (PCOS).

Before ovulation, the levels of pro­gesterone are about 2 to 3 mg per day; when ovulation begins and the corpus luteum develops, the production of progesterone rapidly rises to an average of 22 mg per day. A week or so after ovulation it reaches peak production as high as 30 mg per day. If fertilization does not occur after 10 or 12 days, then the production of progesterone falls dramatically, triggering the shed­ding of the lining of the uterus and resulting in menstruation.

Progesterone is also an important hormone during pregnancy. It prepares the lining of the uterus for the fertilized ovum and is necessary for the survival and development of the embryo. Progesterone is produced in the pla­centa (which maintains pregnancy), and is secreted at a level of 300 to 400 mg a day during the third tri­mester.

In a woman’s menstrual cycle, estrogen and progesterone levels should rise from the time of ovulation until just before menstruation. If progesterone levels are inadequate, only estrogen rises, po­tentially causing symptoms such as:

  • Low blood sugar levels
  • Salt and fluid retention
  • Blood clotting
  • Fibroid or tumor development
  • In­creased cholesterol and triglyceride levels
  • Allergic reactions
  • Reduced oxygen levels in the cells
  • Re­tention of copper
  • Loss of zinc
  • Interference with thy­roid hormone function, which may lead to weight gain and feelings of exhaustion

Other Roles of Progesterone

After menopause, the ovaries no longer make progesterone, but it continues to be produced elsewhere in the body, such as in the adrenal glands and nerve cells. Although it is considered primarily a “reproductive hormone,” progesterone provides benefits to all cells in the body, including those in the brain, heart, nerves, and bones:

  • Progesterone produced by cells in the body’s nervous system helps form the protective layer around nerve endings known as the myelin sheath, which insulates the nervous system and speeds up neurotransmission.
  • Bioidentical progesterone helps protect against cardiovascular disease by lowering high blood pressure, reducing arterial spasms, and inhibiting cholesterol buildup.
  • Research indicates that progesterone stimulates new bone growth while inhibiting bone loss, thus offering protective effects against osteoporosis.

Progesterone’s Many Benefits

  • Acting as a precursor of other sex hormones (i.e., estrogens and testosterone)
  • Protecting against fibrocystic breasts
  • Acting as a natural diuretic
  • Helping use fat for energy
  • Acting as a natural antidepressant
  • Promoting thyroid hormone action
  • Normalizing blood clotting
  • Restoring libido
  • Normalizing blood sugar
  • Regulating zinc and copper levels
  • Restoring proper cell oxygen levels
  • Stimulating osteoblast-mediated bone building
  • Promoting cortisone synthesis as a precursor in the adrenal cortex

Many healthcare practitioners prescribe estrogen alone (with no progesterone) for a woman who has had a hysterectomy. While she may no longer need that protection, her body still needs progesterone’s protective benefits. For example, breast tissue is highly sensitive to hormones, especially estrogen, which encourages breast cells to proliferate and may lead to breast cancer. Progesterone counterbalances that proliferation and promotes normal cell growth.

Bioidentical progesterone is extracted from wild yam and soybean and prepared in a laboratory to chemically duplicate the progesterone produced in the body. It combines with progesterone receptor sites and elicits the same biological effects with little risk of serious side effects. Possible side effects from taking progesterone include feelings of euphoria and possibly an alteration in the timing of the menstrual cycle.


While testosterone is often synonymous with masculinity, it also plays an im­portant role in a woman’s normal physiology. Women produce a small amount of testosterone, which is critical to the healthy functioning of most of the tissues in the body. On average, women with functioning ovaries produce 0.3 mg of testosterone per day (men produce 20 times as much).

Testosterone’s obvious function in both men and women is sexual:

  • At puberty, testosterone promotes the growth of pubic and underarm hair (along with estrogen).
  • Testosterone initiates oil production in the skin, which contributes to teenage acne but also gives shine to the hair and a healthy glow to the skin.
  • In women, testosterone receptors in the nipples of developed breasts, in the cli­toris, and the vagina make these areas sensitive to sexual stimulation.
  • During pregnancy, it signals the cells of the genetically male em­bryo to develop as a male.

Additionally, testosterone plays an important role in keeping the cells of the body func­tioning efficiently, promoting healthy bones and muscles, and mak­ing the best use of nourishment for growth and maintenance.

Causes of Testosterone Deficiency in Women

Testosterone and estrogen are car­ried on the same protein in the blood, known as the sex hormone-binding globulin (SHBG). Between 97-99% of testosterone is attached to this protein, leaving little left over to affect the tissues in the body. Estrogen stimu­lates the production of more SHBG, which binds up more testosterone, leaving less available to work on the cells.

Women commonly experience a decrease in testosterone after menopause, which may result in symptoms of decreased sense of well-being, a loss of vital energy, and reduced sexual libido. When taking supple­mentary estrogen at menopause, women tie up a little more of the testosterone that’s left, which may cause symptoms of testosterone deficiency. However, some women are reluctant to try testosterone supplementation because they’ve heard that significant growth of facial and body hair is a side effect; however, these unwanted side effects usually occur only at excessive dosage levels, and discontinuing testosterone supplementation reverses this adverse effect.


The thyroid gland produces hormones that regulate metabolism. The principal hormones secreted by the thyroid gland are triiodothyronine (T3) and thyroxine (T4). Nearly 80% of the thyroid gland’s production is devoted to T4; however, T3 is the more active form of thyroid hormone and converts from T4 in the liver and kidneys.

If the conversion of T4 to T3 is impaired so that there is a deficit of T3, symptoms of hypothyroidism may persist, even with thyroid replacement therapy. Thyroid problems are a com­mon health problem for women. Once properly identified, proper hormone replacement therapy can remedy the majority of thyroid dysfunction symptoms.

The reason so many thyroid problems go undiagnosed may be partly due to shortcomings in testing. The most common method of diagnosing thyroid function is to measure TSH and T4, and sometimes T3, with a laboratory blood test. Unfortunately, this method has sometimes yielded inaccurate measurements, and may even miss cases of thyroid system malfunction.

Thyroid Supplementation

The predominant thyroid therapy is levothyroxine, which contains only T4. Many patients do not convert T4 to T3 at a sufficient rate (or at all), necessitating a treatment that supplements both hormones. Most thyroid hormone treatments prescribed by healthcare practitioners must be monitored.

Based on his research into the efficacy of both natural and synthetic thy­roid, Dr. Broda O. Barnes advocated the use of natural preparations. T4 preparations, which are the most commonly-used thyroid hormone, have proven to be a poor replacement according to the Barnes Foundation. Their testing has shown that patients on T4 preparations have abnormally high T4 levels and low T3 levels, indicating their body’s inability to convert T4 to T3.

Examples of Thyroid Deficiency Symptoms

  • Frequent headaches
  • Repeated respira­tory infections
  • Weakness and/or fatigue
  • Depression
  • Dry skin
  • Lethargy
  • Slow speech
  • Decreased sweating
  • Cold sensations
  • Cold and/or pale skin
  • Thick tongue
  • Coarsened of hair
  • Impaired mem­ory
  • Constipation
  • Edema of eyelids
  • Heart enlargement


Dehydroepiandrosterone (DHEA) monitors, supports, and regulates the functions of other steroids in their immune system ac­tivity. It is the most abundant steroid hormone secreted by the adrenal glands. The body uses DHEA to produce tes­tosterone, estrogen, progesterone, and corticosterone.

The function of DHEA appears to be impor­tant in retaining the metabolic balance of youth. Levels of DHEA are high in the developing fetus and continue to rise until about the age of 25. After this point, its production drops off sharply: the average woman at age 50 has less than one-third of the DHEA she had at age 19.

DHEA Supplementation

DHEA is available by pre­scription when it is custom-compounded. It is also available without a prescription (over-the-counter). Proponents of DHEA supple­mentation believe it may have a positive impact on a wide variety of health conditions.


Problems associated with hormone fluctuations are not necessarily “normal” or inevitable. Regulating hormone balance may be a useful tool in maintaining and enhancing good health at every stage of a woman’s life. Whether it is PMS in their 20s and 30s, menopausal problems in their 50s, or osteoporosis in their 70s and 80s, women do not have to accept these health problems as part of the aging process.

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  • Colgan M.Hormonal Health: Nutritional & Hormonal Strategies for Emotional Well-Being & Intellectual Longevity. Vancouver, Canada; Apple Publishing: 1996.
  • Melville A.Natural Hormone Health: Drug-free ways to balance your life. New York, NY; HarperCollins: 1990.
  • Lee JR. What Your Doctor May Not Tell You About Menopause: The Breakthrough Book on Natural Progesterone. New York, NY; Warner Books, Inc.: 1996.
  • Lee JR. Natural Progesterone: The Multiple Roles of a Remarkable Hormone. 4th ed. Sebastopol, CA; BLL Publishing: 1993.
  • Nachtigall LE, Heilman JR. Estrogen: The Facts Can Change Your Life!2nd ed. New York, NY; HarperCollins: 1995.
  • Rako S. The Hormone of Desire: The Truth About Sexuality, Menopause, and Testosterone. New York, NY; Harmony Books: 1996.

Connections is a publication of Women’s International Pharmacy, which is dedicated to the education and management of PMS, menopause, infertility, postpartum depression, and other hormone-related conditions and therapies.

Information Use and Disclaimer: This information is not specific medical advice. It should not be used to decide whether or not to prescribe any medication. Only the healthcare provider has the knowledge and training to decide which treatments are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition, and does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. Patients interested in any medications compounded by Women’s International Pharmacy are encouraged to speak to a medical professional.

Publisher: Women’s International Pharmacy
Editor: Laura Strommen; Samantha Lebsock, PharmD
Writer: Carol Petersen, RPh, CNP; Michelle Violi, PharmD

Copyright © Women’s International Pharmacy. This newsletter may be printed and photocopied for educational purposes, provided that your copy (or copies) include full copyright and contact information.

For more information, please visit or call 800.279.5708.

Women’s International Pharmacy | Madison, WI 53718 | Youngtown, AZ 85363

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