Women’s Health:

Hormone Balance and

Stress
Henri J Roca, MD
Assistant Professor, Department
of Family Medicine, University of
Arkansas School of Medicine
 Estrogen and Progesterone
 During reproductive years, ovaries
make high amounts
 Estrogen peaks at the beginning of cycle
 Progesterone peaks after ovulation
 Small amount of both made in Adrenal
glands
 Some estrogen also made in fat cells
 Symptoms Associated with Menopause

 Hot flashes, flushes, night sweats and/or cold flashes, clammy

feeling
 Bouts of rapid heart beat
 Irritability, Mood swings, sudden tears
 Trouble sleeping through the night (with or without night
sweats)
 Shorter, lighter periods; heavier periods, flooding; phantom
periods, shorter cycles, longer cycles
 Loss of libido
 Crashing fatigue
 Anxiety, feeling ill at ease
 Feelings of dread, apprehension, doom
 Reproductive Hormones and
Dental Health
J Midlife Health. 2014 Jul-Sep; 5(3): 115–120; Ann Med Health Sci Res. 2013 Jul-
Sep; 3(3): 320–323.
 Estrogen receptors in oral mucosa similar to
vaginal mucosa
 Natural menopause is defined as a spontaneous
cessation of natural menstruation for 12
consecutive months at 45-55 years of age
 paucity of saliva, increased dental caries,
dysesthesia, taste alterations, atrophic gingivitis,
periodontitis and osteoporotic jaws unsuitable for
conventional prosthetics or dental implants.
calcified carotid atheromas.
 ORAL MANIFESTATIONS
 Effect on periodontium
 Periodontitis
 Oral candidiasis
 Localized osteitis
 Burning mouth
 Trigeminal nerve involvement
 Xerostomia and increase caries activity
 Delayed healing
Progesterone and Pregnancy
 Increased in puberty, with OCP, during
pregnancy
 Changes in blood flow – red gums, more
reactivity to plaque
 Acid erosion
 morning sickness or esophageal reflux.
 Periodontal disease occurs in 50% to 100%
of all pregnant women
 Peri-Menopause
 Time from when symptoms start, lasting to 1
year after last menstrual period
 Symptoms:
 Increased PMS
 Irregular periods, or changes in length and flow
 Hot flashes, night sweats
 LH and FSH will be elevated: trying to get
the ovaries to make estrogen
 Ovaries respond with periodic bursts: Hot
Flashes
 Hot Flashes
 80% of American women will have at least 1
hot flash
 Surge of power, heat, or energy being released
 Some completely debilitated
 Thought to result from fluctuations in
estrogen levels
 During peri-menopause, but can continue
into menopause
 Exacerbated by low progesterone levels
 Peri-Menopause
 Progesterone levels decline due to lack
of ovulation
 Increases in frequency through the 40’s
 Too much estrogen relative to
progesterone
 Estrogen Dominance
 Estrogen Dominance
 Common symptoms
 Fibrocystic breasts
 Fibroid tumors of the uterus
 PMS symptoms
 Breast tenderness and water retention
 Mood changes
 Menstrual symptoms
 Menopause symptoms - especially hot
flashes
 Menopause

 Decreased estrogen and progesterone levels

 Begins 1 year after last period

 Low Thyroid and/or low adrenals will make

symptoms worse
 Burning Mouth Syndrome
 43% peri and menopausal; 6%
premenopausal
 Xerostomia
 Estrogen receptors in salivary glands
 Flow rate including stimulated flow rates
are lower in postmenopausal women
 Salivary pH and electrolytes are unaffected
 Mandibular dysfunction, diffuse gingival
atrophy or oral ulcerations, oral candidiasis,
pernicious anemia
 Periodontal Health
 Estrogen receptors in periodontal
osteoblasts and fibroblasts
 Decreased vascular flow in menopause
 Worse and more frequent periodontal
disease
 Alveolar Bone Loss
 Strong association with osteoporosis
 Counseling Meditation

Phytonutrients
Exercise Detoxification and
Biotransformation
Inflammatory
Structural Nutrient excess Excessive Process
exercise Vitamins
Integrity Infectious micro-
Dysbiosis Spiritual
organisms
Minerals angst Nutrient
Situational insufficiency
stress – fear,
anxiety, worry The holistic/ functional Xenobiotics
medicine model Psychological
Immune Structural or Adiposity
and Spiritual
Surveillance physical damage recognizes and prioritizes
Drug side effectsthe patient’s full, unique Disrupted light Equilibrium
cycles – circadian
Hypoglycemia story and dysrhythmias
uses fundamental clinical Diet
Toxic metals
imbalances as a key Hyperglycemia
Excessive noise to treating complex,
Biofeedback Radiation
chronic illness.
Digestion, Genetic pre- Emotional
disposition trauma
Absorption, (SNPs)
Food toxicants Oxidative
(allergens, stimulants Aging
and Barrier etc,) Reductive
Integrity Homeodynamics

Hormone and Yoga

Neurotransmitter Regulation
Homeopathy

Manipulative
Acupuncture Therapies
ENTER THE MATRIX
BRUXISM
 Adrenal Glands
 2 glands, located on top of each kidney
 Cortisol: main stress hormone
 Sex hormones also made here
 DHEA, Testosterone, Progesterone, Estrogen
 As we age, Ovaries make less E and P
 Adrenals pick up the slack
 Healthier the adrenals, easier the transition to
menopause
 Acute Stress
 High Cortisol
 Initially DHEA can be elevated
 Eventually, DHEA, T and E decrease because
all raw material is being diverted to make
Cortisol
 High Cortisol is good in acute situations:
 Increased blood sugar for fuel
 Shunt blood to periphery to run
 Decrease inflammation to manage response to
injury
 Chronic High Cortisol
 Raises blood sugar - insulin/diabetes
 Abdominal obesity - risk for metabolic
syndrome
 Fluid retention and hypertension
 Breakdown of structural proteins - muscle
(sarcopenia), bone and connective tissue, hair
and nails
 Impairs immune system
 Chronic infectious diseases
 Lowers sex hormones
 Chronic Stress:
Adrenal Fatigue
 Eventually, low Cortisol
 Saliva testing
 Low DHEA, Testosterone
 Less Estrogen and Progesterone
 Worsens symptoms of peri and menopause
 Symptoms:
 Fatigue
 Hair loss
 Joint pain and inflammation
 Allergies
 Auto-immune disorders
 Thyroid Gland
 Low functioning - hypothyroidism
 High TSH, low T4, T3
 Nutritional causes- iodine, zinc, selenium, iron
 Auto-immune - Hashimotos Thryoiditis
 Symptoms
 Low body temperature, cold hands
 Sluggish metabolism, weight gain
 Fatigue
 Constipation
 Depression
 Low libido
 Menstrual disorders, severe menopausal symptoms
 Hair loss, dry skin
 Thyroid Hormones
 Thyroid gland makes T4 (4 iodine molecules)
 T4 delivers an iodine to all cells in your body
and is activated to T3
 T3 much more potent
 Many people have subclinical
hypothyroidism from low T3, or problems
with activation of T3, or removal of wrong
iodine
 Dependent on progesterone and cortisol,
among other nutrients (more later…)
 Stress Issues and
Achieving All-Hormone
Balance
 Stress and Thyroid
Function
 Stress suppresses hypothalamus’ release of
TRH, the pituitary’s release of TSH, and
thyroid gland production of thyroid hormone
 Decreased TSH, T4, T3
 Chronic stress: don’t convert T4 to T3
 Inflammatory cytokines - block conversion
 Adrenal exhaustion - low cortisol
 Cortisol needed for T4 to T3 conversion

 Healthy Adrenals Key to Healthy Thyroid

 Stress and
Estrogen/Progesterone
 High Cortisol causes worsening of
Estrogen Dominance, low Progesterone

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Progesterone and Thyroid

 Progesterone helps convert T4 to the

activated form of T3
 Stress, adrenal fatigue and Peri-
menopause/menopause all cause low
progesterone
 Negatively effect the thyroid
 Can’t balance thyroid without balancing the other
hormones
 Treatment approaches:
Perimenopause
 Chastetreeberry (Vitex): balances
estrogen and progesterone
 Compounded progesterone cream
 Hot flashes
 Not Effective:
 Wild yam cream
 Dong Quai root
 Evening Primrose
 Vitamin E
 Ginseng
 Treatment Approaches:
Menopause
 Mind-Body Medicine: Studies show
reduction of hot flashes with:
 Relaxation
 Self-suggestions of cool thoughts
 Temperature feedback
 Training in slow deep breathing
 Black cohosh (Remifemin 20 mg twice)
 Isoflavones from soy, kudzu
 Soy: Exact mechanism not known. Possibly
by weak estrogenic activity: blocks harsher
estrogens
 Treatment Approaches:
Menopause
 Bio-identical Hormone Replacement
Therapy: Bio-HRT
 Vaginal Dryness:
 Estradiol only Estrogen cream: Estrace: 2
grams per night X 2 weeks, then 1 gram, 1-2
X week.
 Sexual activity will increase mucus
 Avoid excess douching
 Treatment Approaches:
Thyroid
 Iodine, Zinc, Selenium, Vit A
 Kombu
 Brazil nuts
 Thyroid hormone replacement
 Synthetic T4, T3 (Synthroid, Levoxyl,
Thyrolar, Cytomel)
 Natural T4, T3 (Armour, Naturthroid)
 Treatment:
Adrenal Fatigue
 Lifestyle factors
 Nutrition: Low sugar and not skipping meals
 Stress Management: physical and emotional
 Sleep - 7-9 hours
 Exercise - not too much or too little
 Remove toxins - caffeine, alcohol, drugs,
environmental
 Targeted Supplementation
 Adrenal Supplements
 Herbs, including Rhodiola - adaptogen
 B5, B6, Vit C
 L-tyrosine - especially good for
depression, low energy
 Licorice root - especially for
inflammatory conditions
 Mind-Body Techniques
for Balancing Stress
Hormones
 Relaxation  Imagery/Self-
 Breathwork hypnosis
 Autogenics and  Exercise
Biofeedback  Prayer
 Meditation
 Bone Building
 Estrogen  Vit D
 Testosterone  Calcium
 Raloxifene  Magnesium
 Calcitonin  Boron
 Exercise  Strontium
 Sunlight  Orthosilisic Acid