The “Why” Behind Hormone Decline: Dysfunction in Three Endocrine Glands
I have a novel idea. I like to call it “the three domains of healthy aging.”
Once we reach 35, our sex hormones (estradiol, progesterone and testosterone) start to decline. This brings with it myriad debilitating symptoms.
We have three glands that are constantly at work to keep our bodies balanced: the pancreas, the ovaries and the adrenals. These three domains of health are all interrelated and it’s common for them to get off track as we age.
When we focus on optimizing each of them and improving how they communicate with one another, we can reduce the risk of chronic disease. This comes from restoring function (or replacing hormones) in each of these three domains.
The Pancreas: Insulin Resistance
Glucose regulation in our bodies is a complex dance. The food we eat is digested into glucose. When this glucose enters our bloodstream, our pancreas is instructed to release insulin. Insulin is an essential hormone and necessary for regulating our blood sugar levels. When our body does not react to insulin properly, we are left with excess levels of blood sugar. This excess blood sugar causes our bodies to store more fat, especially in our midsection.
Estrogen decline in mid-life can precipitate insulin resistance in women.. Estrogen helps modulate our glucose levels and makes our cells more sensitive to insulin (the opposite of insulin resistance). When insulin sensitivity is poor, this leads to persistent fatigue and stress, hormonal abnormalities, and greater fat storage.
THE SOLUTIONS
Get at least 100 grams of protein per day. Very few women get enough protein each day, but it makes such a difference when it comes to sustaining energy and balancing our blood sugar. 100G is a starting point - most women need more.
Stay moving. Physical activity is essential for balancing your blood sugar and optimizing your overall health. I recommend resistance training and walking.
Cut out sugar and refined carbs. Opt for organic fruits and vegetables, pasture-raised animal protein, and nuts and seeds.
Monitor your blood sugar. This is the best way to hone in on what choices best balance your glucose levels. Every single body is unique, which means what works for one person may not be what works for you.
Don’t overdo it. Taking extreme measures, such as under-eating and intense workouts often has the opposite effect on our bodies. Nurture your body, don’t destroy it.
The Adrenals: Stress + Exhaustion
When I gave birth to my third baby, I was a new midwife, sharing a call schedule with three other midwives (and spending a lot of nights rushing off to the hospital. Sleep was extremely hard to come by, and stress was high, with three children under five at home, a partner with a busy career, and myself trying to navigate a new (and high stakes) job. It actually hurts to think back to this time, and in some ways, I wish I could have a do-over. I regret being so committed to pushing through, that I made so little time for myself and my new baby. Sure, his needs were met - he was exclusively breastfed, and I spent all of my time off by his side. But I was so depleted, and reaching for gluten-free muffins, lattes, and dark chocolate to get me through the long days and nights. One year after he was born we all got the flu (and it was a nasty one). Then, everyone got better - except me. One month later I was seeing patients in the clinic when one of the physicians pulled me aside and said “You don’t look so good.” It turned out I was walking around with a high fever and active pneumonia. My biggest worry when I found out? Telling my boss. When I laid in bed that day sweating and with chills, I wondered - was it all worth it? Why am I still pushing through when my body so clearly can’t keep up?
Right after this, I found functional medicine - and slowly discovered that nurturing my stress response and thereby by my own needs had to come first in my life if I wanted to feel better and to thrive.
Let’s unpack the stress response and adrenal health:
I consider there to be “four cornerstones” of adrenal health: inflammation, insulin resistance, circadian rhythm and psychological stress. Stay tuned for a future blog post where we will dive into each of these cornerstones. While the first three are important physiologic contributors, we are going to focus on the psychological contributor today: stress in your forties.
Women over 35 are living in what is called the “sandwich generation.” We’re caught between caring for our parents and caring for our children. We’re trying to save for retirement while simultaneously paying off student loans and a mortgage.
Stress has become so commonplace for women at this stage of life, and when we fail to manage it, our overall health is impacted. Excess stress prevents our body from functioning as it should, particularly our HPA axis.
The HPA axis contains three structures that play a pivotal role in how our body responds to stress: the hypothalamus, the pituitary gland and the adrenal glands. Each component of the HPA axis affects the other, so when one is not functioning normally the whole system is compromised.
When we face an acute stressor, our cortisol levels elevate. Once the stressful stimulus is gone, our cortisol levels naturally go down. When we are exposed to chronic stress, however, our body’s stress response doesn’t get the respite it needs and cortisol continues to be released. The interesting thing is, we don’t burn out - high stress actually impairs the ability of our HPA axis to communicate within the system (and with other hormone glands like the ovaries - think the stress/fertility connection).
As our ovaries age and make less estrogen, we rely on healthy communication in the HPA axis. This is why declining estrogen can make you stress tolerance tank as you age.
The Solutions
Make time for breathwork. I am a huge advocate for breathwork. It’s so simple and only requires a few minutes out of your day (but can make such a difference in your overall stress levels).
Keep a regular sleep schedule. This means aiming for 8 hours each night and trying to go to bed and wake up at the same time each day.
Take frequent walk breaks. Movement is one of the best ways to quiet all those thoughts running through your mind. I love taking evening walks after dinner.
Set boundaries and keep them. This might be one of the most difficult things for us women to tackle, but it is crucial.
Avoid anxiety-inducing foods. Coffee, alcohol, and juices are examples of foods that spike our anxiety levels. Try calming foods instead, such as avocados, seeds, turmeric, and chamomile tea.
The Ovaries: Ovarian Senescence
Your ovaries have a timeline that other glands do not have. So many factors affect the age of your ovaries, with some prolonging the lifespan of your ovaries and others accelerating the aging process.
Let’s take a look at the hormones your ovaries produce and that decline as you age:
Progesterone tells our body to thicken our uterine lining during the second half of our menstrual cycle. While progesterone is vital for maintaining a healthy pregnancy, this is not its only function. It has an anti-inflammatory effect on our body, helps to regulate our thyroid, and plays a huge role in our mood (hence why it’s often called the “feel good hormone”).
So, when our progesterone levels are low we notice significant emotional changes. Most commonly, we see increased anxiety and depressive symptoms. It’s not uncommon for this to progress in anxiety disorders and depression, which is a prevalent diagnosis for women at this age. Thyroid dysfunction and systemic inflammation are also common in our forties.
Estrogen is responsible for our female characteristics, including breast and hip development. However, it also regulates our insulin response, protects our body from bone and muscle loss, and benefits our heart health. Depleted estrogen has also been linked to cognitive decline. Estradiol (a form of estrogen) has neuroprotective properties, reducing a woman’s risk of developing neurodegenerative disease.
So, when our estrogen is depleted we experience insulin resistance (as we discussed above), muscle mass reduction, and an increased risk of fractures and osteoporosis. Estrogen decline is also behind those bothersome brain fog and memory symptoms that many women report during this transitional time.
THE SOLUTIONS
Know what factors accelerate ovarian aging:
Oxidative stress
Smoking
Lack of sleep
Chemotherapy
Toxicity (the ovaries are like sponges and pick up all of what we are exposed to)
Follow an anti-inflammatory diet. This means plenty of healthy fats, leafy greens and antioxidant-rich fruits (such as wild blueberries).
Strive for a low-stress lifestyle. You need to prioritize your mental health in order to optimize your overall health.
Consume or supplement with fatty acids. Incorporate plenty of fatty fish and nuts + seeds. I also recommend a high-quality fish oil supplement.
Cut out processed foods and replace them with nutrient-dense ones. Cutting out sugar and refined carbohydrates has a huge impact here.
Remember: a big factor behind ovarian hormone depletion is just natural aging. You can slow this aging to a point, but sometimes your hormones end up needing to be replaced. I recommend bioidentical hormone replacement therapy.
Continue to follow this blog series to learn more about how to optimize your hormonal health.
Sources:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6341301/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4261347/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7097676/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3102368/
