Women start to experience the effects of hormones at the onset of puberty, when mood swings and changes in skin, sleep, and weight start to make a difference in everyday life. But among the not-so-enjoyable changes there are huge potential benefits. According to The American Heart Association, higher estrogen levels tend to raise HDL (good) cholesterol levels and keep blood vessels flexible within the inner layer of the heart’s arterial walls, easing blood flow, which means estrogen could be linked to healthier hearts in teenage girls. However, eating healthy and getting annual wellness exams to confirm the heart and body are functioning optimally are critical, since estrogen can start to dip in a woman’s late 20s and again after 35.
As women enter this stage in their life, they may be thinking about starting a family, making hormones even more important. Healthy hormone levels, including estrogen, usually mean a good environment for conception. However, some women who are in the healthy hormone range still struggle to conceive. About one in 10 women between the ages of 15 and 44 have difficulty getting or staying pregnant, according to the Centers for Disease Control and Prevention, so it’s important for women to stay attuned to factors that may offer hints about future fertility challenges.
“Menstrual irregularities off birth control, or skipping periods for more than 40 days between periods, can be signs of an ovulation problem,” says Dr. Wesley Grootwassink of OBGYN West. For women under 35 who have trouble becoming pregnant, a gynecologist can rule out common infertility causes like endometriosis and pelvic inflammatory disease, and discuss symptoms such as irregular or painful periods.
The good news is, the medical field knows more about hormones and their link to overall health now than ever before, which has led to better diagnostic testing, including checking the follicle stimulating hormone (FSH) and estrogen to measure fertility. These tools are especially important for women in their 40s who experience a continued decline in estrogen before they enter menopause. For women trying for a baby, this makes getting pregnant harder.
“If you’re 35 or older, and have a known fertility factor, you should at least be addressing that with your OB or us within six months [of trying to conceive],” says Dr. Colleen Casey, board-certified endocrinologist at the Center for Reproductive Medicine. Since she began practicing in 2008, Casey says there have been advancements in fertility options, specifically with In Vitro Fertilization (IVF), which is good news for women of any age struggling to get pregnant. “The success rate has gone up, and the ability to test for chromosome abnormalities has improved,” Casey says. These advancements open the door for more women to achieve the pregnancy they’ve been hoping for.
Dr. Annelise Skor Swigert, Southdale OBGYN, says, “As you go through your 30s, your fertility goes down until you hit 40, and by then we know that out of every egg ovulated, probably less than half are going to be viable eggs to make a healthy pregnancy.” While those statistics are reality, getting pregnant isn’t impossible. She adds: “I tend to see an educated population of women, and studies show that women with post-graduate education tend to marry later, and have children later.” These women will likely need to spend more time discussing fertility options with their doctors, and monitoring their bodies throughout the month, since hormone levels affect ovulation.
Fertility isn’t the only reason women should continue seeing their gynecologist. A woman in her 40s can have irregular bleeding and changes in mood, skin, and sleep as a result of changing hormone levels. These women may benefit from birth control pills containing estrogen and progesterone, to balance hormones and alleviate those problems,” Swigert says. “The pill is not for everyone, but it’s an option if you’re a good candidate for it. There’s also a hormone IUD that can be helpful for women having issues with bleeding or a progesterone-only pill that some will take only two weeks out of the month that can help a lot with mood.”
Finding the correct balance of hormones can make a big difference to a woman’s everyday health and happiness.
A Healthy lifestyle
A healthy weight is important, but it’s critical if you’re trying for a baby. “Overweight women have a much harder time getting pregnant and a much more difficult time with pregnancy,” says Dr. Annelise Swigert, Southdale OBGYN. “I’ll see women who are 32 and overweight and I’ll suggest they lose 30 to 45 pounds before getting pregnant.”
Weight loss isn’t easy, but being smart about it helps. Dr. Wesley Grootwassink, OBGYN West, says, “The worst thing that can be followed is a low-fat diet, which shifts the calories to carbs—and that has a significant impact on health and weight, especially for someone who’s had difficulty ovulating in their earlier years.” Nutritionists can customize meal plans, answer questions, and suggest exercises for the best results.
One of the most noticeable changes women experience in their lifetime occurs with the onset of menopause, when estrogen production suddenly decreases—and that goes beyond hot flashes. Since estrogen is linked to heart and bone health, monitoring health at this stage is critical.
“Doctors and medical professionals know that when a woman goes through menopause it’s very important to have her estrogen replaced because estrogen is usually a cardio-protective hormone. So when you lose estrogen, it’s universally accepted that a woman’s risk for heart disease, stroke, and other kinds of heart diseases increases,” says Dr. Melvin Ashford, medical director at Minnesota Women’s Care.
Since estrogen’s effect on the body is so important, the medical field has been studying how much estrogen therapy is safe for women, and which women would benefit most from estrogen-related treatment. In 2002, the Women’s Health Initiative halted a five-year study when it concluded that estrogen hormone therapy for menopausal women was linked to an increase of breast cancer in the study participants. These results, however, have since become controversial.
Dr. Philip Marcus, Obstetrics, Gynecology and Infertility, disagrees with the Women’s Health Initiative study, noting that its findings became a scare tactic that was more harmful than helpful to women. “The study perpetuated that women were going to get breast cancer and dementia [through estrogen hormone therapy]—so everyone stopped taking estrogen,” Marcus explains. “Five years later, they released the study again, and separated those participants into age groups, and the outcome was good. In the medical field, you have to look at age groups and how that affects results.”
Ashford agrees with Marcus about the misguided findings: “The average age of women in that study was 65—which means that most of these women had a higher risk of those things anyway. . . . When they looked at the study again, they saw that women who take hormone therapy before age 60 actually live longer, have lower risk of heart attacks and strokes, and low risk of breast cancer.” Menopausal women who do not adjust their hormone levels by taking estrogen supplements are putting vital organs at risk of failing, which can cause serious problems or death.
“We’re giving hormones to women not just for symptoms. We’re really doing it for their heart, brain, and bones—three areas that are very, very affected by not having estrogen,” Marcus says. Estrogen allows bones to absorb calcium and other nutrients that keep them strong and healthy, protecting against breaks and fractures. The National Osteoporosis Foundation estimates that women in menopause can lose up to 20 percent of their bone density from the lack of estrogen.
Hormonal shifts can also mean changes in the bedroom. Estrogen prepares vaginal tissue for sex by keeping it lubricated and pliable. Without it, sex can be painful, and the negative impact it has on relationships can take an emotional toll.
“I’m a sexual dysfunction expert, and that’s a big issue for women of all ages and especially in menopause because they assume they’re not supposed to have sex anymore, and that’s not true,” Marcus says, cautioning that lubricants will make the ease of intercourse possible but it won’t take the pain away afterward because the vaginal tissue isn’t flexible enough for sex. “There are two types of estrogen made specifically for breast cancer and stroke patients,” Marcus says, adding that you’ve got to advocate for what you need from your doctor. These estrogen supplements stay at the bladder and vagina—they’re not taken orally, and are used to soften and moisten vaginal tissue and hopefully eliminate pain during intercourse.
Fortunately, the fix for all these common menopause-related issues is relatively simple. And there are many options: pills; patches; topical creams, gels, and sprays; vaginal suppositories; and pellets. Doctors can talk about the pros and cons of each method, and address each woman’s individual concerns and priorities, which influence the best approach to hormone therapy. But, doctors say oral hormone therapy is mostly discouraged because of the higher risk of blood clots and strokes as a result of the liver absorbing the medication before it’s distributed into the bloodstream, adding those unnecessary risks.
“You want to avoid giving women oral estrogen if you can help it . . . and you should start hormone therapy as early as possible in menopause to get the best benefit for your brain and heart,” Marcus says. “Use a system estrogen that goes through the skin or the vagina. Patches are the most popular, or rings you can put into the vagina that go directly into circulation—all of those things skip the liver and don’t put you at an extra risk of stroke or dementia. You get protection without the risk.”
While many women rely on patches and rings, another approach, pellet therapy, is gaining momentum locally.
“Pellet therapy isn’t new, but it’s relatively new to the Twin Cities. Basically, a pellet the size of a piece of bird seed is put under the skin, and it slowly releases hormones 24 hours a day directly into the bloodstream, which mimics the body’s natural way of producing small amounts of hormones constantly,” says Ashford. “Most women are a good candidate for this, including women with a risk of breast cancer. Pellet therapy allows for control of the ratio of one hormone to another, which is key to preventing breast cancer.”
A pellet with a customized amount of hormones is inserted through a tiny incision in the flank, where it remains for about four months until it needs to be replaced. The whole in-office procedure only takes about five minutes.
But for breast cancer patients or those with an increased breast cancer risk, talking to a doctor before starting treatment is important. “We think that [breast cancer is influenced] by a type of estrogen—there are three different kinds: estriol, estrone, and estradiol—so it’s what type of estrogen you’re taking, how you’re taking it, and how long you’re taking it that needs to be discussed. But from what I’ve found and learned, probably the safest way is with pellet therapy,” says Ashford.
Marcus elaborates that estrogen doesn’t cause breast cancer, it can add fuel to a breast cancer patient who is in remission or at an increased risk of estrogen-dependent breast cancer, so discussing other therapy options is important. “Antidepressants and other [non-estrogen-related] medications can decrease hot flashes but they don’t work well and they still cause vaginal dryness, which interferes with sex,” says Marcus. The American Cancer Society agrees: “The benefits of taking [hormone medication] outweigh the risks for almost all women with hormone receptor-positive invasive breast cancer.”
Women’s bodies are designed to experience so many changes, and as health care evolves, it’s important to stay on top of wellness from head to toe, especially where hormones are concerned. As outlined, they play an important role in nearly every aspect of a woman’s life, so make checking them a priority every year.
Be Heart Smart
It’s clear that the chemistry of women and men is different, and that difference is also true with symptoms of a heart attack. “While men often present with chest pressure, arm pain, and jaw pain,” says Dr. Lucy Esberg, cardiologist at North Memorial Hospital, “many women have shortness of breath, heartburn, fatigue, and dizziness—these symptoms can be very non-specific, which can delay the diagnosis of heart disease.” In a 2012 study, the Centers for Disease Control and Prevention estimated that roughly 64 percent of women who died suddenly from heart disease had no indication there was a problem.
Heart attacks that happen without symptoms are so common they’ve got a name: silent heart attacks. “Silent heart attacks are just as dangerous as heart attacks that cause symptoms because the lack of blood flow can damage the heart muscle,” says Dr. Elizabeth Tuohy, cardiologist and medical director of the Heart Disease Prevention Clinic at United Heart & Vascular Clinic. Women’s intuition may offer a defense. Tuohy adds that symptoms can be subtle—or non-existent—but it’s important not to ignore it when something doesn’t feel right. “A woman who thinks she’s having a heart attack should advocate for herself that she thinks she’s having a heart attack, not an anxiety attack,” she says.
Being proactive about health is a lifesaver. “Our best defense as women is understanding our bodies, leading a healthy lifestyle, and advocating for ourselves when something has changed,” says Esberg. Taking control of health means consulting with a doctor to establish the baseline of heart health. From there, create a health care regimen, and request cholesterol, blood pressure, and calcium tests, which can assess heart disease risk.
“An increase in calcium levels equals an increased risk of heart disease,” says Dr. Aimee Johnson, cardiologist at Park Nicollet Heart and Vascular Center. “I frequently use this test in women who don’t have any symptoms of heart disease, but may have a family history of early heart disease or multiple risk factors. The calcium score also detects subclinical coronary disease, where we can detect plaque before it causes symptoms, and apply aggressive risk factor management to slow the progression.” Working with a doctor to go over lab results can bring peace of mind and an action plan to avoid or prepare for the worst.
When alone and experiencing a heart attack, call 911, and, Johnson suggests, “chew four baby aspirin to quickly release them into your system, and rest quietly to try and decrease your heart rate and blood pressure, which can strain the heart and make symptoms worse.”