Premenopausal Women/PMS Symptoms
The term “estrogen dominance” can be confusing at times because it does not relate solely to the amount of circulating estrogen in the body, but rather to the relationship between estrogen and progesterone. Contrary to popular belief, many of the symptoms experienced during PMS are not due to estrogen deficiency, but rather are due to estrogen dominance.
Although estrogen levels do decline with age (approximately 40 – 60% at menopause), more relevant is the fact that, at menopause, progesterone levels plummet by close to 90% from premenopausal levels. It is the relative loss of progesterone that causes the majority of symptoms termed “estrogen dominance.” This disproportionate loss of progesterone begins in the latter stages of a woman’s reproductive years, when impairments to the luteal phase of the menstrual cycle begin.
The reduction in progesterone production is initiated when the remnant tissue of the follicle post ovulation (called the corpus luteum) begins to lose its functional capacity. Outside of pregnancy, the corpus luteum is the primary source of progesterone in the female body. By the time a woman reaches her mid-thirties, luteal phase defects are common and result in decreased progesterone production by the corpus luteum. Also increasingly common beginning at this time is anovulatory cycles which result in a lack of corpus luteum formation and thus, a virtual lack of progesterone production. It is during this time that a relative progesterone deficiency, or what has become known as estrogen dominance, develops.
Typical symptoms of estrogen dominance are PMS symptoms such as mood swings, irritability, water retention, headaches, fatigue, breast tenderness/fibrocystic breasts. Prolonged estrogen dominance can result in depression, irregular or heavy periods, increased facial hair, hot flashes, vaginal dryness, uterine fibroids, decreased libido, diffuse aches & pain, sleep disturbance, osteoporosis, memory loss, lack of concentration, dry skin, and thinning of scalp hair.
Patients experiencing these symptoms will likely benefit from hormone balancing treatments including natural hormone replacement. The most effective way to assess hormone status is to test saliva for the appropriate hormone levels. Saliva is the best method for testing “functional” or “active” tissue levels of hormones.