Many symptoms that women experience as they age can be related to changes in hormone production by the ovaries, but thyroid and adrenal gland hormone production and function are also very important. There are other abnormal hormone patterns that relate to and exacerbate certain gynecologic disorders such as estrogen dominance, which occurs when a woman does not have normal production and breakdown of hormones to maintain normal hormone levels and normal cycling.

We now have access to very advanced hormone testing to help optimize how hormones behave. Female hormone cycling is an intricately controlled system that includes the hypothalamus, pituitary gland, adrenals, thyroid and ovarian tissues. This regulation involves negative and positive feedback loops. These tissues are all susceptible to injury or dysfunction, especially by toxic exposure and chronic inflammation, which are often related to lifestyle.

Stress is a major driver and has a profound, direct effect on adrenal function, which can then impact all other systems in the body. A highly processed diet that is high in processed grains, industrial seed oils and sugar is likely to be a problem, as is poor gut health. Many factors impact hormone function over a woman’s lifespan, including environment, genetics, nutrition, physical activity, sleep, mindset and habits.

Hormone Therapy

There is good evidence to support the value of a comprehensive approach to optimizing feminine health, both in alleviating symptoms and improving function. While hormone therapy became very controversial more than two decades ago, there is good evidence that bioidentical hormone therapy can promote anti-aging and be cardioprotective when started soon after the onset of menopause. Hormone therapy provides chemical messages to every tissue in the body to control the actions of cells and organs. It is very effective at relieving moderate to severe menopausal symptoms like hot flashes, night sweats, insomnia, vaginal dryness, urinary symptoms, mood changes and decreased sex drive, while also protecting bones, and heart and brain function as women age.

Bioidentical hormone replacement therapy is derived from plant sources and comes in various forms, dosages and formulations that can be customized when necessary. All women should consult a well-informed practitioner about these therapy, as well as integrative alternatives that may also be effective at alleviating symptoms. What should result is an individualized approach to hormone health with comprehensive hormone testing and functional blood testing, followed by a detailed discussion about the risks and benefits of bioidentical hormone replacement therapy, in light of the patient’s current health status.

Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder of reproductive-aged women, but it is also associated with metabolic disorders like obesity, diabetes, metabolic syndrome and gestational diabetes. It is predominantly characterized by irregular menstrual cycles, excessive testosterone and cystic ovarian changes on pelvic ultrasounds. Women with PCOS also often struggle with infertility, most frequently due to anovulation [the lack or absence of ovulation]. Testosterone excess primarily results from overproduction in the ovary, which may manifest clinically as hirsutism [abnormal growth of facial hair], acne and hair loss (androgenic alopecia), with 60 to 70 percent of those diagnosed affected.

Endometriotosis

Endometriosis is a condition where tissue similar to the interior lining of the uterus, or endometrium, migrates and implants in areas outside the uterus, primarily in the pelvic region. Sometimes endometrial tissue can be found in more distant locations. These implants respond to monthly fluctuations of a woman’s hormones (estrogen and progesterone) during her menstrual cycle. Estrogen stimulates these implants to grow. The implants may break down and bleed, but there is no exit route for the tissue to leave the body. This leads to painful menstruation, abdominal pain and inflammation that can lead to adhesions, scarring, internal bleeding, bowel or urinary dysfunction, bloating, constipation, painful intercourse and infertility.

Endometriosis affects 200 million women worldwide and approximately one in 10 women in the U.S. It strikes women from all racial, ethnic and socioeconomic backgrounds. There is no clear cause and no cure, although it is treatable. There is often a delay in diagnosis as symptoms may initially be minimized. Medical treatment focuses on managing symptoms, with previous standard treatment being birth control pills and pain killers. Newer drug formulations target the hormonal effects of estrogen and progesterone on the implants. In severe cases, surgery may be indicated, however, it is common for it to reappear if not addressed in a fully integrative way.

A Function Approach

Functional medicine takes a more holistic view of endometriosis as an inflammatory disorder. A typical support protocol will include steps to balance female hormone levels, support hormone detoxification pathways, support the immune system, work on gut health to ensure a balanced microflora (as this directly influences the immune system), remove anything that may be contributing to inflammation (including environmental exposures) and place patients on an anti-inflammatory diet and supplements. Other lifestyle measures are incorporated to manage stress and sleep and minimize toxic exposure.

Uterine fibroids are very common, affecting approximately 70 percent of women at some point. Many of these cases go undiagnosed because they are asymptomatic. Heavy bleeding or painful menses are the most common symptoms associated with these benign tumors. Women with fibroids report decreased quality of life due to symptoms of bleeding and/or pain, as well as pressure or bulk symptoms if the mass is large, contributing to urinary frequency or constipation. African American women are disproportionately affected, and often at a younger age.

From a functional medicine perspective, fibroids likely indicate some hormonal imbalance, and toxic exposure has been implicated as playing a role in the development of symptoms. Heavy metals, persistent organic pollutants and PCBs have also been correlated with uterine fibroid development. A significant, dose-dependent connection between hair relaxers and fibroid risk also suggests that some African American women may be exposed to more and different chemicals than many white women. Recent data suggests EGCG in green tea has potential to offer some relief of symptoms for uterine fibroids, PCOS and menopause due to its antiangiogenic, antifibrotic and antioxidant properties.

Cancer

Digital mammography, a low-dose X-ray, shows the inside of the breasts and is the most widely studied and established screening tool for breast cancer. It has been evaluated in numerous clinical trials and has been shown to reduce breast cancer mortality in certain populations, but false positives may occur in approximately 10 percent of cases. Additional imaging with sonography may be necessary if breasts are very dense or breast MRI may be indicated if there is increased personal breast cancer risk identified.

Some have recommended other screening methods due to concern about repeated radiation exposure to breast tissue over a woman’s lifetime with mammography. Breast thermography is a non-invasive imaging technique that uses an infrared camera to measure the heat emitted by the surface of the breasts. It is based on the idea that cancer cells tend to have a higher metabolic rate and therefore may emit more heat compared to normal cells. There are no specific recommendations for initiating or frequency of performing thermography, but it could be useful to perform between mammogram screening if that is not being done annually or for screening younger women that are at risk.

The U.S. Preventive Services Task Force recommends biennial screening mammography for women aged 50 to 74. The decision to start screening mammography prior to age 50 should be an individual one. They have concluded that the current evidence is insufficient to assess the balance of benefits and harms of screening mammography in women aged 75 or older.

Breast cancer is the most diagnosed cancer among American women. Black women are more likely to die from breast cancer than women of any other racial or ethnic group. Experts believe this is partially because one in five Black women is diagnosed with more aggressive triple-negative breast cancer.

Eighty-five percent of breast cancers occur in women that have no family history of breast cancer, and are likely preventable. Just being a woman and growing older are the two biggest risk factors for breast cancer. Those factors are difficult to change, but other risk factors such as smoking and drinking alcohol can be stopped while eating a healthy diet and exercising regularly. Breast cancer screening, monthly breast self-exams, an annual exam by a doctor and regular X-ray and thermographic breast imaging are important tools for breast cancer detection—especially early detection, when cancers may be more treatable.

Regular Maintenance

All women should have regular checkups and functional lab testing to be evaluated for possible nutrient deficiencies, metabolic dysfunction, inflammation, abnormal thyroid or adrenal function, or toxicity, as well as comprehensive hormone testing to identify and address any underlying imbalances and correct them. These will likely include lifestyle and dietary changes to shed any excess weight gained while rebalancing hormones.

Phyllis J. Gee, M.D., is the founder and medical director of Willowbend Health & Wellness, in Plano. For more information, visit WillowbendHealthandWellness.com.