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Hormonal Issues: Common Complaints and Symptoms
Many women come in to our office with the complaint of hormonal issues. What that means can vary greatly. Some women experience irregular periods; other women notice vaginal dryness and decreased libido. Many other symptoms exist including hair loss, fatigue, weight gain, pain with sex, etc. Because these symptoms can have both hormonal and NON-hormonal causes, it is essential that a full evaluation be done to assess for possible causes to ensure that the treatment is targeting the cause rather than masking a symptom.
Irregular periods can be either too frequent, erratic, or too far apart. A normal menstrual cycle should be consistent throughout the year. Cycle lengths of 21 to 35 days are considered appropriate as long as each cycle is within +/- 2 days of the average length. For instance, if your cycles are 23 days, there might be variation from 21-25 days. Alternatively, if your last few cycles were 21, 35, 28 days – THAT is abnormal. Cycles that are shorter than 21 days or longer than 35 days are also considered abnormal. Irregular bleeding like this can be caused by hormonal, infectious (bacteria), or anatomic (polyps, fibroids) problems. Each of these potential causes must be evaluated to understand why the irregular bleeding is occurring. It is not always caused by hormonal issues.
Vaginal dryness is a common complaint during postpartum breastfeeding and menopause. This can be caused by hormonal issues such as the lack of estrogen production from the ovary. When breastfeeding exclusively (no formula supplementation or solid foods), ovarian function is suppressed by prolactin – the hormone secreted to support milk production. During this time, hormone levels of both estrogen and progesterone levels are very low. The hormone levels of estrogen and progesterone can also be very low during menopause when ovarian function has stopped. The lack of estrogen at the vagina causes the mucosa (skin) of the vagina to lose its elasticity and moisture production. During sex, women can have difficulty with pain due to tiny splits and abrasions to the vaginal skin. Hormonal replacement of estrogen to the vagina through vaginal cream or systemic estrogen (oral or topical) can correct this. Alternatives include IntraRosa (DHEAS) and Osphena (estrogen reuptake modulator) which create estrogen-like effects through alternative mechanisms.
Decreased libido is a complex multifactorial issue. Libido is influenced by the health of the relationship (feeling loved and appreciated), the health of the individual (fatigue, depression, body image, etc.), and hormonal factors. Because the health of relationship and self are often under strain in our Western culture, low libido is commonplace. Hormonal issues such as low estrogen, progesterone and testosterone levels can also contribute to low libido. Unfortunately, taking testosterone only improves libido in about half of women who try it. The hormone testosterone can also improve muscle development, but at the same time can adversely affect cholesterol, hair growth/loss, and behavior. Addressing the health of the relationship/self and supplementing testosterone together have the best results in improving libido.
Hair loss frequently occurs during postpartum breastfeeding and menopause. It can also occur due to vitamin/mineral deficiencies, scalp infections, thyroid malfunction, over-secretion of the hormone testosterone, cancers, etc. Evaluation of hair loss should be comprehensive and not focus only on hormonal causes. The treatment to stop hair loss depends on the underlying cause which may include hormonal supplementation – but this is not always necessary. As with the other issues addressed above, a multi-pronged approach to treatment is essential to determine if they are caused by hormonal issues.
There are many other concerns that are frequently attributed to hormonal imbalance, such as fatigue, weight gain, pain with sex, etc. Each of these issues require an evaluation of anatomic, infectious, AND hormonal components to obtain the optimal treatment success. It is important to ensure that your doctor or mid-level provider takes this thorough approach to determine if your symptoms are caused by hormonal issues or not.
Additional Reading – Hormonal Issues
To learn more about hormonal issues, please read: