Shortly after puberty, hormonal changes begin. Oestrogen levels begin to rise and secondary sexual characteristics develop. Follicles – capsules within the ovaries – increase and decrease in size each month on a cyclical basis. The capsule will often contain an oocyte (egg). Oestrogen is produced from the capsule and so as the follicle develops in size to a maximum around the middle of the month, oestrogen levels correspondingly rise and then following ovulation – release of the egg, the capsule shrinks away and oestrogen levels fall. The fall in oestrogen results in a withdrawal bleed – the menstrual period. In the first few cycles after puberty, the development in the follicle can be quite erratic and as a result the rise and fall of oestrogen levels can be variable. Generally, as the oestrogen levels rise, individuals feel well but as the oestrogen levels fall, this results in symptoms.
One of the most common symptoms is excess production of adrenaline (called vasomotor) and this can affect thermal regulation with feelings of heat during the day and also at night, excess anxiety or feelings of unexpected stress and flight or fight symptoms even if there is no cause for this, heart racing and disturbed, poor quality light sleep. This results on fatigue on waking and the feeling of being unrefreshed and having difficulty getting out of bed in the mornings. Further adrenaline surges can lead to feelings of anxiety throughout the day. Mood changes also occur when oestrogen levels fall due to changes in serotonin metabolism as well as gradual sleep deprivation often due to the impaired sleep quality. The mood can be short fused and irritable or weepy and emotional.
Falling oestrogen levels can also affect the vessels causing production in the artery diameter for reducing blood flow. When the oestrogen levels fall therefore symptoms such as loss of memory and concentration, clumsiness, lack of special awareness, headaches, restless legs and cold fingers or tingling can occur due to less oxygenation of the tissues in the body due to the arteries constricting. As the oestrogen levels lift again as the menstrual period commences, these symptoms will often improve.
Falling oestrogen levels before the menstrual period can affect the collagen matrix making this much more weak and less elastic. Some females experience joint pains before their menstrual periods, dry mouth, dry eyes and blurred vision, vaginal soreness and bladder irritability symptoms. Inflammation such as rosacea and some eczemas can also worsen before the menstrual bleed.
Insulin is a hormone produced by the pancreas to stabilise blood glucose levels. When oestrogen levels fall such as before the period or if they remain low (due to poor development of the follicles particularly in the teenage years) excess insulin can be produced. This can lead to symptoms such as excess carbohydrate and sugar cravings, a drop in sugar levels resulting in afternoon fatigue, feelings of hunger/anger due to hypoglycaemia and mood changes. Excess insulin also worsens inflammation such as exaggeration of pre-existing eczema, joint pains etc.
The bowel wall is sensitive to oestrogen and when oestrogen levels fall, particularly premenstrually, the forward movement of the bowel reduces which can lead to a reduction in transit time. Constipation can occur but the bowels even in the short term can be very much more bloated and swollen. This often corrects shortly after the menstrual bleed occurs and when oestrogen levels naturally lift.
The pelvic floor is extremely sensitive to oestrogen and when oestrogen levels fall or are remaining low, both the vaginal epithelium and vulva can become dry, sore and inflamed. Because of the change in pH, there can be an increased tendency to infections such as thrush, vaginosis and generalised infections.
The bladder base is also very sensitive to oestrogen and when hormone levels remain low, the bladder becomes much more irritable with poor emptying and in some cases a tendency to overactivity including wetting or bladder pain and an increased tendency to develop bladder infections.
This includes a combination of topping up falling oestrogen levels particularly if the symptoms are severe such as premenstrually. There are many different forms of “bio-identical” or “human-identical” oestrogen, including gels, patches and sprays. These oestrogen products which absorb through the skin are not strong or synthetic like the oestrogen contained in contraceptive pills so therefore will not have a contraceptive effect as they do not switch off the menstrual cycle; they simply supplement the oestrogen that the ovary is producing particularly if the levels are seemingly inadequate. Checking oestrogen levels is not possible as these fluctuate so much throughout a normal menstrual cycle so it is best to monitor symptoms. Using oestrogen gel for example one to two pumps massaged into the arms and legs twice daily premenstrually or a spray can help supplement or correct the rapidly falling levels at this time and whilst this may not completely relieve the PMS/PMT symptoms this can certainly help. The timing of commencement of oestrogen supplementation is usually around 7-10 days before the menstrual period is expected but most females will become adept at recognising when their symptoms are beginning to occur and commence the oestrogen supplementation then.
Most females will then find it acceptable to discontinue the oestrogen supplements at around the second or third day of the menstrual cycle when the oestrogen levels naturally lift.
If the oestrogen levels are permanently low due to poor follicle development (see link below), often during the teenage years, then oestrogen supplements may be required throughout the cycle. If this is the case, then supplementary progesterone will also be required to both protect the uterus and regulate the bleeding pattern.
Hormone levels change during a cycle and with individual cycles depending upon the development and quality of the follicle which produces the oestrogen. Some females may feel absolutely fine at the beginning of the cycle and then experience severe symptoms in the second half of the cycle or they may feel unwell throughout the cycle but with further even more severe symptoms as their oestrogen levels dip coming up to a bleed.
If the bleeds are absent or erratic, this usually means that the follicle development is also unreliable and irregular and oestrogen levels similarly will be very variable. In these circumstances it is almost certainly best to switch off the ovarian production of oestrogen for a while. This is called downregulation of the ovaries. There are several ways of doing this including: taking a combined contraceptive pill or even a mini pill (progestogen) although the progestogen-only pills are not quite so effective at switching off the fluctuations. Using a depo-progesterone device can also switch off the ovaries and fluctuations and some patients may consider having an intrauterine progesterone device inserted to switch off the ovaries and in just switching off the fluctuations in hormone levels is enough to help improve the symptom response but in a large number of cases the individual then experiences permanent symptoms of low oestrogen and may need to use some addback oestrogen gel, patches or spray.
Occasionally, oestrogen tablets can be used particularly if the skin based preparations are not effective or a longer lasting effect is required. Once again, this is not like a contraceptive pill but is pure oestradiol so therefore activates steady supplement particularly if there are cases of low mood permanently, brain fog and poor concentration and collagen symptoms such as joint pains.
It is important to be aware that each female has individual symptoms and the severity also hugely varies between individuals as well as the timing in the cycle and the cycle itself. Being aware of the symptoms and being able to monitor therefore and adjust the supplements is so important as these can be life changing and extremely simple and inexpensive to address.
Copyright © 2024 Miss Whitcroft - All Rights Reserved.