How to get off the hormone rollercoaster

Life‘s ups and downs getting a bit much? Maybe you‘re being taken for a ride…

Feeling moody, tired or tearful? Periods all over the place? Having hot flushes or struggling to sleep? There’s a good chance it’s down to your hormones. These are the body’s chemical messengers, regulating a range of functions from appetite and metabolism to periods, sleep cycle and heart rate.

When hormones are in balance, things run smoothly. It’s when they get out of kilter that the trouble begins.

This doesn’t mean having to live life on a rollercoaster. We asked health experts who specialise in common hormone-related conditions for advice on dealing with the symptoms and different life stages.

Premenstrual Syndrome (PMS)

PMS is a group of cyclical physical and psychological symptoms.

It usually occurs in the two weeks after an egg is released (ovulation) and the beginning of a period. Most women will experience PMS to some degree, but for around 5 per cent the symptoms can be severe.

Tania Adib, a UK consultant gynaecologist at The Medical Chambers Kensington, says too many women simply put up with PMS symptoms without seeking medical help. “Many of these symptoms get worse gradually over time and become the new normal for women,” she says. “They may have only one week a month where they feel okay.

“Even if they do eventually think their symptoms are abnormal, there’s still a reluctance to admit it and discuss feelings such as mood swings or heavy periods with their doctor.”

What’s the cause?

It’s not fully understood what causes symptoms, but they’re believed to be related to fluctuations in hormone levels such as the female sex hormones oestrogen and progesterone. These also affect levels of the feel-good hormone serotonin, influencing mood.

How is it treated?

“If you suffer badly, the first step is to keep a daily diary of symptoms for three months to see if there’s a pattern that relates to your monthly cycle,” says Tania.

“Hormone treatments that inhibit or stop the ovaries functioning can help with symptoms,” she explains.

“Options include the combined contraceptive pill or oestrogen taken through the skin (oestrogel), along with a natural progesterone supplement taken orally or via the Mirena IUS, an implant that releases the hormone levonorgestrel in the womb.”

Some women may also be prescribed selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine for depression and mood swings, to be taken continuously or during the second half of their cycles when symptoms occur.

Diet advice

Eating well will improve your general health and may help with symptoms.

✱ Eat a healthy balanced diet with regular meals to ensure you get a variety of nutrients and keep your energy levels stable.

✱ Include iron-rich foods such as lean red meat, poultry, lentils, tofu, spinach and fortified cereals, as irregular or heavy periods can increase iron loss.

✱ Include more B vitamins. Research has shown those with a high dietary intake of riboflavin (found in dairy, eggs, lean meats and some nuts and greens) had a 35 per cent lower risk of developing PMS than those with low intakes. B vitamins are also found in wholegrain cereals and beans.

Polycistic Ovary Syndrome (PCOS)

Around one in 10 women in Australia and New Zealand (and one in five in some indigenous populations) are affected by PCOS.

The main features are an abnormally high number of fluid-filled sacs (follicles) forming on the ovaries, a failure to ovulate, an irregular cycle and high levels of ‘male’ hormones, including testosterone.

You won’t necessarily have all of these, and symptoms vary greatly (see p33). “For instance, around 20 per cent of women with PCOS won’t have cysts (empty or immature follicles) on their ovaries. And others have an abnormal number of cysts and irregular periods, but don’t have high levels of male hormones,” explains Dr Georgios Dimitriadis, senior clinical fellow in endocrinology, diabetes and metabolism at Coventry and Warwick University Hospital, who runs a specialist PCOS clinic for the UK’s NHS.

What’s the cause?

The precise cause is unknown, but we do know PCOS is an interplay between sex hormones and metabolism, explains Georgios. Many women with PCOS have insulin resistance and in turn, PCOS is associated with a higher risk of developing insulin resistance. When the body becomes resistant to insulin (made by the pancreas to control blood glucose), the pancreas has to produce more, which stimulates the ovaries to produce more testosterone. This so-called ‘male’ hormone is produced by both sexes. Gaining extra body fat as a result of insulin resistance can also produce more testosterone, setting up a vicious circle of high hormone levels, insulin resistance and weight gain.

“PCOS is under-recognised, under-diagnosed and undertreated”, says Georgios. “There’s a massive epidemic of PCOS at the moment, probably because of the increase in obesity. However, around 20 per cent of women with PCOS aren’t overweight, so obesity is clearly not the whole story. The high number of cases may also be because of endocrine (hormone) disruptors in the environment such as chemicals in plastic bottles and processed foods – this is currently being investigated by researchers.”

The longer-term risks

Since PCOS is associated with insulin resistance, there’s a higher risk of developing type 2 diabetes – more than 50 per cent of women with PCOS will develop diabetes or prediabetes before the age of 40. Diabetes, in turn, puts people at higher risk of heart disease and depression. PCOS sufferers also have an increased chance of developing breast or endometrial cancer as some are more likely
to have obesity, which increases the possibility of these cancers.

“The longer-term risks are often overlooked,” says Georgios. “It doesn’t just affect fertility, and its effects continue beyond the menopause. Post-menopausal women with PCOS are at three times higher risk of having high blood pressure, for instance, compared with women without PCOS of the same age and weight.”

How is it treated?

“There still isn’t one definitive test – it’s largely a clinical diagnosis of exclusion,” says Georgios. Tests include blood tests for high levels of male hormones and blood glucose, and ultrasound scans of the ovaries. The first-line treatment is usually to offer lifestyle advice to help the patient manage their weight.

“The contraceptive pill may be prescribed to restore periods,” he says. “But although this can help with some symptoms such as acne and excess body hair, it just masks the fact that you’re not ovulating or ovulating irregularly.

“Losing even a small amount of weight (5–10 per cent) can have a significant effect on symptoms, helping to restore ovulation and lower insulin resistance, for example. Taking regular exercise can also help reduce insulin resistance. Having said that, some women with PCOS find it very difficult to lose weight and one theory is that they have inherited a genetic defect where the body gets a ‘blunted’ signal to burn off calories effectively. This is still being investigated by scientists,” he says.

Other treatments include metformin, a drug which improves insulin resistance, or in some cases bariatric weight-loss surgery. Women with fertility issues may be prescribed the drug clomifene to stimulate ovulation.

Diet advice

Dietary approaches that may help you manage PCOS include:

✱ Go low glycaemic index (GI): eating foods that release energy more slowly, such as whole grains, nuts, seeds, fruits, starchy vegetables and minimally processed foods.

✱ Eating a wide variety of colourful plant foods: providing fibre and plant compounds that support gut health, hormone regulation and inflammation.

✱ Including fermented foods regularly: (think yoghurt, kimchi, sauerkraut etc) which contain beneficial bacteria to support gut health, anti-inflammation and metabolic health.

✱ Go Med-style: emphasise veg, fruit, whole grains, legumes, nuts, extra-virgin olive oil and fish, with some dairy, limited red meat and processed foods, to help reduce inflammation.

Perimenopause

‘This phase usually occurs after 40 and up to five years before you start the menopause,’ says consultant gynaecologist Tania Adib.

“Distinguishing the symptoms from PMS can be a bit of a grey area – it can be a time when many women who have never experienced PMS-type symptoms begin to have them.

“Because they’re still having periods, they may not associate their symptoms with the approach of the menopause, and may be prescribed antidepressants when it’s really their hormones that are to blame,” Tania explains.

What’s the cause?

Fluctuating levels of the female sex hormone oestrogen are believed to be the culprit. Symptoms tend to intensify as levels drop.

How is it treated?

There’s no definitive test for perimenopause. Doctors can run tests to measure hormone levels, but these fluctuate in the perimenopause, so a diagnosis will be based on symptoms.

“Hormone replacement therapy (HRT) can work very well for the perimenopause,“ says Tania. “This is normally a combination of oestrogen and progesterone.

“A lot of women were scared off HRT (otherwise called menopausal hormone therapy – MHT) after a big study in 2002 reported a link between HRT, breast cancer and stroke. But the risk was small when put in context (one in 1000 women will get breast cancer because of HRT and synthetic progestogen will cause the same number of strokes). Now the pendulum has swung back, and more women know that HRT is a safe and acceptable treatment.“

Newer bio-identical treatments, derived from plants and made with molecules identical to the hormones made in the body, include transdermal creams, gels and patches, which are available on GP prescription. These deliver oestrogen through the skin into the bloodstream, where it’s diluted and breaks down slowly, so won’t increase the likelihood of clotting in the liver, and consequently the risk of stroke, in the same way that oral MHT does. Transdermal oestrogen can be taken with natural progesterone, available as a tablet or pessary on GP prescription.

“Some women may have little trouble during this stage of life, while others may benefit from a short course of HRT to help them through an intense period of symptoms. And some may need to use it longer term,’ says Tania.

Diet advice

✱ Protecting against heart disease and falling bone density is important during both the perimenopause and menopause. Aim for 1300mg calcium per day. High-calcium foods include dairy and fortified alternatives.

Menopause

Full-blown menopause happens when your periods stop completely. You’re considered post-menopausal when you haven’t had a period for 12 consecutive months.

How is it treated?

The average age for menopause in New Zealand and Australia is 51-52 years old. Doctors can run blood tests to check your hormone levels if necessary. “Many of the treatments for the menopause are the same as for the perimenopause, including transdermal bio-identical HRT,” explains Tania. “I’m very in favour of women having treatment to help with the menopause rather than suffering,” she continues. “I have women coming to see me who are at the peak of their careers and running family life, too. Suddenly they can’t sleep, feel terribly low and their memory
plays up – it can be very debilitating and life-changing.

“Vaginal dryness can be treated with topical oestrogen cream or tablets. Laser or radiofrequency treatment can be very effective for vaginal dryness/atrophy and help with bladder symptoms such as discomfort and burning.

“Low libido may respond to a low dose of testosterone gel (used off label, as it’s technically licensed to treat men).

“If you’re having ongoing problems that don’t resolve, you can ask to be referred to a menopause specialist – it’s never one size fits all when it comes to treating these symptoms as they vary so much.”

What’s the cause?

“There are oestrogen receptors all over the body that can react to the dramatic drop in oestrogen,” says Tania. “That’s why menopause symptoms can be so widespread.”

Diet advice

Falling oestrogen levels can affect bone density and mean less protection against heart disease. diet recommendations include:

✱ Two to three portions of calcium-rich foods a day, such as yoghurt, cheese or milk, for bone health.

✱ Two portions of fish a week, one of which should be oily, for their heart-friendly omega-3 essential fatty acids.

✱ A heart-healthy, low-sat-fat diet with 30g fibre a day from whole grains, pulses and beans, and at least five serves of fruit and veg a day for a wide range of nutrients.