The balance between these hormones depends on two things: how much hormone the body produces, and how efficiently the body breaks it down and disposes of it. The ovaries are the primary source of estrogen and progesterone in premenopausal women (with estrogen also being synthesized by intestinal bacte ria and by conversion of adrenal hormones to estrogen by the fat tissues); the liver has the major responsibility for inactivating estrogen. The liver tries to make sure the levels of estrogen circulating through the body in a chemically active form don't become too high.
Breakdown in the liver's ability to perform this function affect the levels of estrogen in the body. Both emotional stress and you nutritional habits play significant roles in how efficiently this sys tem will run. For example, excessive intake of fats, alcohol, and sugar stresses the liver, which must process these foods as well as the hormone. With vitamin B deficiency, which can be caused by poor nutrition or by emotional stress, the liver lacks the raw material to carry out its metabolic tasks. In either case, the liver cannot break down the hormones efficiently, so higher levels of hormone continue to circulate in the blood without proper disposal, tipping the balance toward excessive anxiety-producing estrogen.
Other research studies link the emotional symptoms of PMS to chemical imbalances in the central nervous system. Some researchers suggest that the symptoms of anxiety and mood swings are due to a heightened sensitivity in some women to fluc tuations in the body's level of beta endorphins. These substances are the body's natural opiates, producing a sense of well-being and even elation when present in large amounts. (Beta endorphins are responsible for the "runner's high" that many people experi-ence after prolonged aerobic exercise, because exercise increases beta endorphin production.) Beta endorphin levels increase soon after ovulation at mid-cycle and may decline with the approach of menstruation. A fall in beta endorphin levels in women who are very sensitive to the effects of these chemicals or who produce large amounts of beta endorphin could, like opiate withdrawal, cause symptoms such as anxiety and irritability.
Another possible cause of PMS anxiety symptoms may be the lack of sufficient serotonin in the brain. Serotonin is a neurotrans-mitter that regulates rapid eye movement (REM) sleep and appetite. Inadequate levels of serotonin could explain the poor sleep quality with the resultant fatigue, anxiety, and irritability from which some women with PMS suffer. It could also explain, at least in part, why some women with PMS feel that they have such a difficult time controlling their eating habits and managing their food cravings during the premenstrual time. Serotonin is produced in the body from an amino acid called tryptophan. Tryptophan is an essential amino acid that must be replaced daily through adequate dietary intake since our body cannot manufac-ture it from other sources. Good sources of tryptophan include almonds, pumpkin seeds, and sesame seeds.
Many factors increase the risk of PMS in susceptible women. PMS occurs most frequently in women over 30; the most severe symptoms occur in women in their thirties and forties. Women are at high risk when they are under significant emotional stress or if they have poor nutritional habits and don't exercise. Women who are unable to tolerate birth control pills seem to be more likely to suffer PMS, as are women who have had a pregnancy complicated by toxemia. Also, the more children a woman has, the more severe her PMS symptoms.
PMS rarely goes away spontaneously without treatment. My experience is that it gets worse with age. Some of my most uncomfortable patients are women in their middle to late forties who are also approaching menopause. These women often feel they have the worst of both life phases as they pass from their repro-ductive years into menopause. Often, PMS symptoms coexist with bleeding irregularities and hot flashes. Once the PMS is treated, the accompanying fatigue and mood symptoms clear up. Therapies for PMS are discussed in the self help section of this book.
As mentioned earlier, no single hormonal or chemical imbalance has been linked to PMS. Instead, nearly two dozen hormonal, chemical, and nutritional imbalances may contribute to causing the symptoms. Even more confusing for patients and physicians alike is that the underlying causes may differ from one woman to another. As a result, no single wonder drug cures PMS, although many drugs have been tested, including hormones, tranquilizers, antidepressants, and diuretics. Luckily, the anxiety and mood swing symptoms of PMS as well as the physical symptoms respond very well to healthful lifestyle changes. In my practice, I have found PMS to be a very treatable problem. Achieving results does, however, require that women participate actively in their own program, adopt good nutritional habits, and deal with stress more effectively.
Menopause, the end of all menstrual bleeding, occurs for most women between the ages of 48 and 52. However, some women cease menstruating as young as their late thirties or early forties, while others continue to menstruate into their mid-fifties. Anxiety, mood swings, and fatigue often accompany this process as women go through the hormonal changes that lead to the cessation of menstruation.
For most women, the transition to menopause occurs gradually, triggered by a slowdown in the function of their ovaries. The process begins four to six years before the last menstrual period and continues for several years after. During this period of
transition, estrogen production from the ovaries decreases, even-tually dropping to such low levels that menstruation becomes irregular and finally ceases entirely. For some women this transi-tion to a new, lower level of hormonal equilibrium is easy and uneventful. For many women, however, the transition is difficult, fraught with many uncomfortable symptoms, such as irregular bleeding, hot flashes, anxiety, mood swings, and fatigue. As many as 80 percent of women going through menopause experience some of these symptoms.
In my medical practice, I have seen many women who experi-enced marked emotional symptoms while going through meno-pause. In fact, many of my patients have described symptoms similar to those of PMS. The psychological symptoms of meno-pause include insomnia (often associated with hot flashes), irritability, anxiety, depression, and fatigue. As mentioned in the section on PMS, both estrogen and progesterone have been studied for their effects on mood: If estrogen predominates, women tend to feel anxious; if progesterone predominates, women may feel depressed and tired. As women go through menopause, there is first an imbalance in these hormones and finally a deficiency in both as their ovarian production drops to very low levels or ceases entirely. The severity of the symptoms probably depends on the individual woman's biochemistry and on psychosocial factors. Women have worse symptoms if they are under severe emotional stress or have aggravating dietary habits, such as excessive caffeine, sugar, or alcohol intake.
The emotional symptoms of menopause can also be aggravated by lifestyle issues. For some women, the social and cultural factors occurring before, during, and after menopause may be quite stressful. Menopause can be a time when children leave home and move away, major career changes are made, and marriage ends in divorce or starts anew. Of course, these major life changes can occur at other times besides the "mid-life crisis," but the combina-tion of hormonal and biochemical changes plus lifestyle changes can be quite difficult to handle.
There are many effective treatments to reduce the emotional and physical symptoms of menopause. These include hormonal replacement therapy and, in more severe cases, the use of mood-altering drugs. Vitamin, herbal, and mineral supplements help support menopausal women's reproductive and glandular systems. Stress-management techniques and regular exercise may also help restore energy and vitality and stabilize mood. These are discussed in the self help section of this book.
When the thyroid gland excretes an excessive amount of thyroid hormone, hyperthyroidism occurs. This is a potentially serious and dangerous problem if not diagnosed right away. Symptoms of hyperthyroidism can mimic those of anxiety attacks, and include generalized anxiety, insomnia, easy fatigability, rapid heartbeat, sweating, heat intolerance, and loose bowel movements. In fact, the correct diagnosis may often be missed initially, especially with women who are in menopause, if the symptoms are thought to be due simply to stress or the change of life.
Hyperthyroidism does, however, present with other symptoms that should tip off both the woman and her physician that there is a physiological imbalance present. These symptoms include weight loss despite a ravenous appetite, quick movements, trem-bling of the hands, and difficulty focusing the eyes. On a medical examination, many signs of hyperthyroidism may also be present. The skin of a woman with this problem is usually warm and moist. A goiter (enlargement of the thyroid) may be felt by the physician. The skin and hair are usually thin and silky in texture. The eyes usually tend to stare, and in more advanced cases, even bulge from the eye sockets. In advanced cases, there is also muscle wast-ing and bone loss (osteoporosis) as well as heart abnormalities. As you can see, hyperthyroidism causes severe and potentially dan-gerous changes in the body and should be considered when trying to diagnose the cause of anxiety episodes.
A diagnosis of hyperthyroidism can be made early by blood tests that show excessive secretion of thyroid hormones, as well as other changes in the blood. If heart and bone abnormalities are present also, they may show on an electrocardiograph and on x-rays. Once diagnosed, hyperthyroidism should be treated immediately to reduce the hormonal output. Treatments include the use of drugs that suppress and even inactivate the thyroid gland, as well as surgical removal of the thyroid. This is discussed in detail in Chapter 11 of this book.
Women with thyroid dysfunction often have exhaustion in other endocrine glands. The adrenal glands are particularly affected by poor thyroid function, as well as any other physical and emotional stress. The adrenals are two almond-sized glands that secrete several dozen hormones. One of these is cortisol, an important hormone that helps regulate our response to stress. Stress can be a response to strong emotional feelings, such as anxiety or depres-sion, or to physical triggers, such as an allergic reaction, infectious disease, burns, surgery, or an accident. Whatever the source of stress, cortisol lessens its injurious effects on the body, reducing pain, swelling, and fever.
When stress has been recurrent and of long duration, the adrenal glands can become exhausted, mustering less and less ability to buffer the negative effects of physical and emotional stress. As a result of adrenal exhaustion, the individual may experience an increase in fatigue and tiredness. Much rest, stress management, and nutritional support are required to restore the adrenals and rebuild the physiological "cushion" to deal with stress. There are many helpful techniques listed in the self help section of this book to help restore the glandular system.
This condition occurs when the blood sugar levels in the body fall too low. With this condition, people experience many symptoms similar to those of anxiety attacks, including anxiety, irritability, trembling, disorientation, lightheadedness, spaciness, and even palpitations. The dietary trigger for hypoglycemia episodes is excessive intake of simple sugars such as white sugar, honey, fruit juice, white flour products, and sugar-laden desserts such as cook-ies, doughnuts, and candies.
Glucose, or sugar, is critical for survival because it is the major fuel our bodies run on (the brain alone uses up to 20 percent of the glucose available in the body to fuel its normal level of function-ing). However, simple sugars require little processing in the digestive tract and are absorbed rapidly into the blood circulation, overloading the body with fuel. To move this abundance of sugar into the cells where it can be processed and utilized for the cells' energy needs, the hormone insulin is released from the pancreas. Without adequate insulin, sugar cannot be moved into the cells. Unfortunately, when too much sugar is dumped into the blood circulation, usually the reverse situation occurs and too much insulin is secreted. This can actually drop the blood sugar too low (below 50-60 milligrams per milliliter) to levels where the typical anxiety-like symptoms of hypoglycemia occur. Interestingly, drops in the blood sugar level can also occur simply in response to heightened levels of stress, because the body utilizes extra glucose or fuel during this time.