What are these hormones anyway?
Since I’ve been reading and writing about menopause and hormone replacement for a couple of years now, I tend to get ahead of myself.
I assume everyone else has been elbows-deep in it, too. But perhaps we should take a step back and look at the basics for normal people who haven’t made this a part of their entire identity.
Most of us instinctively know that the changes we’re feeling are because of hormones.
But what hormones are we talking about exactly? What roles do they play? And more importantly, when you’re trying to troubleshoot or get help, what lab tests should you be asking for?
Let’s start at the beginning…
What’s a hormone?
Hormones are chemical messengers that tell your body what to do and when. They’re produced in your glands (ovaries, thyroid, adrenal glands and pancreas), and travel through your bloodstream, giving instructions to other body systems.
When most people hear “hormones,” they typically think of so-called “sex” hormones—estrogen for women and testosterone for men. But that’s only scratching the surface.
- Insulin is a hormone—it tells your body how to regulate blood sugar.
- Thyroid hormones control your metabolism.
- Vitamin D is also a hormone, which influences bone health and immune function.
The fact that we don’t even think twice about replacing any of these hormones if we’re deficient, yet replacing our “sex” hormones is somehow controversial, is PREPOSTEROUS.
We would never tell a diabetic, “It’s fine! Your body will adapt!” or “Maybe you should try yoga. It’ll help you relax.”
But I digress…
When it comes to perimenopause and menopause, there are typically 5 primary hormones at play (although dysregulation in these can affect the ones above…but that’s a topic for another day).
Testosterone (T)
You might think it’s odd that I put testosterone first in a conversation about women and menopause, but there’s a good reason.
Most of us were taught that estrogen (E) is the female sex hormone and testosterone is the male sex hormone. But the truth is, women have more circulating testosterone in their bodies than estrogen during our prime reproductive years. I KNOW! I had no idea either. But it’s true!
The reason most of us (including doctors) think that women have more E than T is because they’re measured in different units in lab results.
Typical lab results for estrogen (aka estradiol) are measured in pg/mL (picograms per milliliter).
Typical lab results for testosterone are in ng/dL (nanograms per deciliter)—which is basically 10X pg/mL.
1 ng/dL = 10 pg/mL
So if your labs show an estradiol level of 30 pg/mL and testosterone level of 30 ng/dL, it means your testosterone is actually 10X the level of your estradiol.
Put another way: a testosterone level of 30 ng/dL = 300 pg/mL – 10X higher than estradiol.
T is produced in both the ovaries and adrenal glands (albeit in a smaller amount) and plays a crucial role in:
- Muscle and strength, helping you to stay fit and avoid frailty
- Bone density, supporting healthy bone structure
- Energy, giving us motivation, drive and zest for life.
- Focus, supporting concentration, cognition and decision making
- Mood, helping us to feel engaged, confident and reducing anxiety
- Libido and sexual response, both desire and arousal.
T is the hormone that helps you feel strong, sharp and confident. It gives you “get-up-and-go.”
And when it declines as we age (starting as early as our 30s), that’s when we notice our get-up-and-go has got up and left! We feel tired, unmotivated, lazy and depressed. And sex drive? Never heard of her.
Estrogen (E)
Estrogen plays a crucial role in so many body systems: your brain, bones, skin, heart and mood. It influences your metabolism, supports collagen production for healthy skin and joints and maintains vaginal and urinary health. It even helps regulate body temperature and sleep.
That’s why when E levels dip, we FEEL IT across our entire bodies.
- Hot flashes and night sweats as our temperature regulation goes haywire.
- Mood swings and brain fog – the brain is loaded with estrogen receptors and when they’re starved for E, it doesn’t function well.
- Dry, itchy and thinning skin. It feels like the Sahara all over, your skin takes on that “crepey” look and you might show more bruising than before. Even your ears get super itchy!
- Vaginal dryness and urinary incontinence. Just like the skin on the rest of your body, the skin “down there” becomes dry, itchy and thin, causing painful sex, increased risk of urinary tract, yeast and bacterial vaginosis infections, plus urge incontinence—when you gotta go, you gotta go RIGHT NOW.
- Weight gain, especially in the midsection. There are actually two mechanisms of action here: your metabolism changes because low E affects how our body uses insulin, but also remember that testosterone our ovaries make? When they’re failing and can’t convert the T to E as well, the body needs fat cells to do all that heavy lifting, so it packs on more fat. Good times!
- Heart palpitations – again, there are tons of estrogen receptors in the heart, and when it’s depleted, it causes electrical signals in the heart to misfire, creating arrhythmias and palpitations.
Progesterone (P)
When we’re younger and still cycling, progesterone is produced in greater amounts after ovulation as our body prepares for possible pregnancy. For most, it has calming, anti-anxiety effects and promotes sleep (higher P is one reason you feel so lazy during PMS). P also skyrockets in pregnancy, in part to stabilize the uterine lining to support a fetus.
When P drops in perimenopause, it causes us to feel more anxious, irritable, have trouble sleeping and get that wired-but-tired feeling. And it’s why many of us suffer from abnormally heavy periods. There’s not enough P to stabilize the lining in the uterus, so it sheds…and sheds…and sheds.
Follicle Stimulating Hormone (FSH)
FSH is produced by the brain in the pituitary gland. When we’re still cycling, FSH signals the ovaries to grow and mature an egg each month. As we run out of eggs and estrogen production slows during perimenopause and menopause, the brain tries to “shout louder,” increasing FSH production in an attempt to get the ovaries to respond.
That’s why high FSH levels are one of the lab markers doctors use to confirm menopause—it means the brain is sending the message, but the ovaries aren’t answering.
Luteinizing Hormone (LH)
LH is another messenger hormone from the brain that triggers ovulation—the release of an egg—and signals the ovary to start making progesterone. During reproductive years, LH and FSH work in harmony to regulate the menstrual cycle.
After menopause, when ovulation stops, LH levels stay elevated because the signal keeps firing, even though the ovaries are no longer responding.
I know it’s a lot. But don’t stress.
As you can see, menopause is about far more than declining estrogen. It’s so much more than just hot flashes and night sweats. These aren’t just “sex” hormones.
These hormones impact literally every aspect of our body—from energy and mood to metabolism and sleep to muscle strength and even our digestion.
There’s a complex interplay at work, but I don’t want that to feel intimidating. You don’t have to become an expert in all of this to get help.
But knowledge is power and understanding how your body works can help you find a provider who will at least look at the entire picture, not just estrogen. One who recognizes the role that each of these hormones plays in our overall health and well-being.
I’ll do a deeper dive on lab work in a future post. But wanted to get these basics out of the way first. And I’ve already gone on too long!
**This is not medical advice, and I am not a doctor. The information here is based on my personal experience and research.
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