CHAPTER 1
Achieving Hormonal Balance
What we feel and think and are, is to a great extent determined by the state of our ductless glands and viscera.
— Aldous Huxley
The sudden drop in progesterone levels following birth is a major cause of PPMD. Not all women are hormonally sensitive, but for those who are, this biochemical shift can be quite dramatic. Women who have experienced PMS symptoms with their menstrual cycles are more susceptible to PPMD.
During pregnancy, the placenta produces high levels of progesterone to sustain the pregnancy. Once the placenta (the afterbirth) is delivered, the progesterone levels plummet. For this reason, it's important to look at progesterone levels first. A physician who specializes in complementary and alternative medicine (CAM) is your best choice. He or she may be a naturopathic doctor (ND), medical doctor (MD), or osteopathic doctor (DO) trained in natural or bioidentical hormone therapies.
Progesterone Deficiency
Signs and symptoms of a progesterone deficiency may include amenorrhea (not resuming a period), anxiety, hot flashes, night sweats, insomnia, confusion, depression, and dizzy spells. If the period has returned, the signs will be similar to premenstrual syndrome (PMS) and may include irritability, abdominal bloating and cramping, headaches before the period, moodiness, hopelessness, food cravings, sadness and crying easily. Some women will not have PMS before the pregnancy but will develop it after giving birth. Severe PMS is called PMDD or premenstrual dysphoric disorder and is sometimes treated with antidepressant medications.
Progesterone Testing
Progesterone testing may initially be conducted using saliva or blood samples. If the woman is not cycling and menses has not returned, only one sample is necessary. If she is cycling, a single blood or saliva sample may be taken on the twenty-first day. The chart below shows a series of multiple saliva samples taken for an entire month. This report gives the most complete information about the cycling of women's hormone levels.
Excessive estrogen in the body can cause similar symptoms even when progesterone levels are normal. This is called estrogen dominance and should be ruled out when taking blood or saliva samples.
Natural Hormone Therapy
Natural hormone therapy (HT) uses progesterone derived from fermented wild yam. These hormones are bioidentical, meaning that chemically they are exactly the same as the hormones produced by a woman's body. There are many forms of administration available, including sublingual drops, pellets or troches, topical creams, gels, patches, or oral capsules. I have found the sublingual forms to act the quickest. The dosage is easy to control and generally provides symptom relief within 24–48 hours. They wash out of the body quickly, allowing for simple dose changes.
If the woman is not menstruating, progesterone is used daily until her menses returns. This dosing is also appropriate if she has severe symptoms of PMS that persist through day 1 of the menstrual cycle beginning. Women with estrogen dominance may often need to take the progesterone all month long until their bodies are properly supported. It's safe to take progesterone throughout the cycle. Be aware that some women will not begin menstruating until the progesterone is stopped. I advise women to watch for days 28 through 30, and if the menses does not begin, I recommend stopping the progesterone supplementation for a couple of days to see if the flow begins. If a woman has a strong return of symptoms, it's acceptable to resume the progesterone at any time, even while menstruating. When first beginning HT, it's important to keep track of the menstrual cycle.
In menstruating women, the decision of when to begin supplementation with progesterone is based upon symptoms. Most often, a woman will use the progesterone starting on days 12 through 18, until she begins bleeding. Discontinuing the use of progesterone from day 1 (first day of bleeding) till day 12 (ovulation) follows the body's natural rhythm. (see chart above)
As previously stated, if her symptoms begin early in the cycle or do not end with the beginning of menses, she may use the progesterone daily. It's important to follow the advice of a trained physician and monitor blood levels after beginning therapy.
Some women take a smaller dose of progesterone on days 5 through 12 and then increase throughout the month as their period approaches. This cycling mimics the natural rhythm of progesterone in a menstruating woman.
Benefits of Natural Progesterone Therapy
The benefits of natural progesterone therapy include the stabilization of mood, decreased PMS symptoms, and protection from endometrial and breast cancer. Do not use synthetic progestin found in the birth control pills, Provera, or PremPro. These can cause depression, cancer, and heart disease.
Progesterone also reduces estrogen dominance and decreases anxiety. It's very helpful for treating sleep disorders, night sweats, excessive crying and sadness, delay of menstruation beginning postpartum, or periods that are irregular — either coming too frequently or not at all. It also helps with menstrual cramping and breast discomfort.
Too much progesterone can cause nipple tenderness, and in women who are blood type A, it may cause bloating. Anytime HT is given to a woman, close monitoring of her symptoms and blood levels is important until she has stabilized. It is also important that she is seen by her practitioner weekly until the mood has stabilized. This is especially important if she is having violent thoughts.
Herbal and Homeopathic Remedies
Herbal therapies may be substituted for natural, bioidentical hormones. Vitex agnus-castus (Vitex) or chaste tree berry is an excellent choice for younger women. Depending on the severity of the postpartum mood disorder, it may be advisable to begin with HT, and once the symptoms have stabilized, a change to Vitex can be made safely.
Vitex is similar to progesterone in its effect but is not the same as giving progesterone. It takes longer (usually four to six weeks) for the postpartum mood disorder to improve. For this reason, if a woman is severely suffering from PPD or PPMD, regardless of her age, it may be better to begin with HT.
Regarding the use of homeopathic medicines, it would be valuable to have a complete homeopathic intake with a skilled practitioner. Although women may have the same diagnosis, they may need different remedies based on their homeopathic constitution.
In Conclusion
Generally, hormonal imbalances are caused by a deficiency in progesterone levels...
