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- Hi, I'm Susan Taylor with Scripps Health
in San Diego, California.
Ladies, are you feeling tired, bloated, irritable?
You might be having problems with your hormones.
Joining us to talk about diagnosing
and treating hormone related medical issues
is Dr. Sarah Dalhoumi.
She is a family medicine specialist
with the Scripps Center for Integrative Medicine
in La Jolla, California.
Dr. Dalhoumi thanks so much for being with us.
- Hi Susan, thanks for having me.
- So let's start off with the basics, what are hormones?
- Sure, so hormones are our body's chemical messengers.
An example of that would be thyroid hormone.
So we all know the thyroid hormone affects our energy
and our metabolism.
When we think of hormones,
they're produced by a system, for example, the brain,
and then released to other systems like the thyroid gland
that then releases thyroid hormone that travels in the blood
and affects our body's metabolism,
so weight gain, weight loss,
can affect our energy, our sleep, our mood.
- Hormones regulate many functions
for the endocrine system in the body.
What is the endocrine system?
- So the endocrine system refers to just what I said.
It's that complex communication system
between different organs and body parts,
and then hormones that are released into the blood.
And then they're carried downstream to their end sites,
so different cells that they'll bind.
- And how does a woman's menstrual cycle
affect hormone levels?
- Sure, so when we think of a menstrual cycle,
we're talking about two female sex hormones
that are fluctuating and changing,
and those are estrogen and progesterone.
And with the changes that happen
during the menstrual cycle, other hormones are impacted.
So for example, toward the end of a woman's menstrual cycle,
estrogen and progesterone will precipitously dropped
right before they get their period.
For a lot of women, they can have symptoms of PMS and PMDD.
So things like bloating, irritability, heightened anxiety,
but other hormones are implicated as well.
So there's that decrease in estrogen and progesterone,
but hormones like dopamine, our feel good hormones,
can also be lower, serotonin,
aldosterone, which is a hormone
that causes fluid retention and bloating.
So a lot of different hormones are related
to different times in the menstrual cycle.
- And what about hormones during pregnancy?
- Sure, so during pregnancy,
there's a lot of hormonal change
and the female sex hormones, estrogen,
can become very, very high.
There are also changes in other hormones,
things like thyroid hormone.
So I would say pregnancy is a condition
where hormones undergo a great state of flux or change.
- And then at the opposite end of the spectrum,
what happens when a woman enters
perimenopause and menopause,
what happens to the hormones then?
- Yeah, that's a great question.
So when I describe kind of reproductive years,
I always tell patients
that it's like a wave of female sex hormones.
You get waves of estrogen and progesterone,
and it's really nice and predictable.
We then transition to perimenopause.
So that's that time sandwich
between our reproductive years and menopause.
During perimenopause the female sex hormones,
and again, specifically estrogen and progesterone
start to look like a rollercoaster.
So if you were to plot them,
they're moving in the downward direction.
Once a woman reaches menopause,
the average age is about 51, 52,
the hallmark of menopause is estrogen and progesterone
that are so low they're undetected in the blood.
So you can see a significant hormone change happens
during perimenopause and menopause.
- And what causes hormone disorders?
- That's another great question.
There are a lot of different conditions
that can cause imbalances or changes in hormones.
There are genetic links.
So sometimes conditions that our family members have had,
but also a lot of lifestyle changes.
So the way we move our body or the lack thereof,
the foods we eat,
so something like maintaining a healthy body weight
can really help stabilize and create hormone balance.
- And what are the symptoms of these hormone disorders?
- Sure, so a lot of symptoms can come about
depending on what hormones
are out of whack or out of balance.
So you can think of hormones affecting metabolism,
so symptoms like weight gain or weight loss,
hormones that affect mood,
so things like mood irritability,
heightened anxiety.
Hormones also impact our sleep,
so difficulty falling asleep or staying asleep.
Those are also symptoms
that could point at a hormone imbalance.
- And you treat these hormone issues, imbalances, disorders?
- So the first part of that is identifying
what the underlying cause is.
And so there's a lot of symptom overlap
with hormone imbalances.
Examples would be hypothyroidism,
which is low thyroid or perimenopause and menopause.
There's some symptom overlap.
So we want to identify first what the underlying cause is,
and then we can figure out the appropriate treatment.
And for a condition like underactive thyroid,
hypothyroidism, it can be as simple as repleting
the thyroid hormone that's missing in the body.
- What is hormone replacement therapy?
- So bio-identical hormone replacement therapy
is when we give a woman estrogen and progesterone,
in most cases, to kind of help their transition
through perimenopause and menopause.
So we talked about how those levels decrease
and are pretty low if at all present once we hit menopause.
By giving a woman estrogen and progesterone
during that transition time,
we can help with menopausal symptoms.
- And is there an alternative
to hormone replacement therapy?
- Absolutely, it's not a one size fits all.
When I'm at seeing a woman
for perimenopausal or menopausal symptoms,
it's, again, first assessing what her current symptoms are,
how severe are the hot flashes and night sweats,
brain fog, mood irritability, sleep troubles.
And then depending on that,
we also look at a patient's family history,
their personal history, what their goals of care, right?
Everybody has a different mind frame on that
and comfort level.
We use bioidentical hormone replacement therapy
in appropriate conditions and cases.
Also use nutraceuticals.
So nutraceuticals are plant-based supplements
that often have a very low side effect profile if at all,
but can have significant symptom improvement,
can help with hot flashes and night sweats.
They're also non-hormonal pharmaceuticals.
So those are FDA approved medications
that don't have hormone modulating activity.
They're not hormones, but they can help with symptoms.
And then adjunct therapy.
So things like acupuncture and hypnotherapy
can be really helpful for menopausal symptoms.
- If you're having hormone-related issues,
who should you be talking to?
Should you be talking to your primary care physician?
Should you be talking to your gynecologist
or an endocrinologist?
- Great question, and the answer is all of the above.
I would say I encourage all my patients
to have an open conversation with all their doctors.
It usually starts with the primary care doctor
that's who usually you see most often,
and most primary care physicians
are very comfortable treating hormone imbalances.
But if it requires a little deeper investigation
or thorough evaluation,
endocrinologists are really great as well as gynecologists.
- And what causes a hormone imbalance?
- So there are a lot of different causes
of hormone imbalances,
and sometimes we don't even know the clear answer to that.
But examples would be genetic predisposition.
So sometimes it's something
that we've inherited from mom or dad.
An example of that would be a condition
like Hashimoto's thyroiditis.
So that's an autoimmune condition that affects the thyroid.
And there is thought to be a genetic link with that.
Other things can be exposures, environmental exposures.
So a lot of different conditions
that can cause hormone imbalances.
- And talk about the Scripps Center for Integrative Medicine
and how you bring this holistic approach
to women's health and wellness,
which includes what the mind, the body, and the spirit.
- Absolutely, we really treat the body as a whole.
Oftentimes, if you're just treating one part,
you're missing a whole other piece of valuable information.
And so the first part of what we do here
is really spending time with our patients
and understanding what they're going through,
what their concerns are.
And also, another important piece is understanding
what their day to day functioning looks like.
How do they eat? How do they move their body?
How do they manage stress? How's their sleep?
Because a lot of that will dictate
how they feel on a regular basis.
We use a lot of different healing modalities.
So we do all the routine testing
that all your other doctors will do.
We'll order all the appropriate
imaging studies if necessary.
But we spend a lot of time on education,
educating our patients, talking about, again,
the foods that they're putting in their body,
what they're exposing their body to in terms of,
there are things called endocrine disruptors.
So there are chemicals, things in the air
and things we put in our body, things we're exposed to,
that it can affect our hormones.
So really kind addressing day-to-day functioning
and how we can make improvements on that.
We have healing modalities as well,
things like acupuncture, biofeedback.
We have an integrative nutritionist here at our center.
So we really do emphasize the mind, body, spirit,
a full patient care model.
- And can you use that mind, body, spirit
to treat hormone related issues?
- Absolutely, I do it on a daily basis.
Really, it's about assessing again
what someone's going through.
What are their concerns? What are they feeling?
Cause I always tell patients
only you know what it feels like to be in your body.
I'm here as a guide to help support you
and give you the information, the knowledge,
and the resources to improve upon that.
- If these hormone issues are left untreated,
what can happen?
- So there are a lot of consequences
to hormone imbalances being left untreated.
And so different things like high blood pressure,
increased risk of cardiovascular disease,
and even cancer risk.
So a lot of important reasons why we want to make sure
we're appropriately identifying, addressing,
and treating these hormone imbalances.
- Any final thoughts doctor?
- Sure, I would just say in closing
that at the end of the day,
listen to your body and what your body's telling you.
If something feels off,
if you're not feeling quite yourself, listen to that.
I would say have that conversation,
talk with your physician,
and have it addressed and worked up
and just make sure we're not missing anything.
- Dr. Dalhoumi, thanks so much for being with us.
We appreciate you taking the time.
- It's been a pleasure, thank you Susan.
- If you want more information on how to recognize
and treat women's hormone issues,
just click on the link or go to scripps.org/videos.
Want more critical information about your health?
Please subscribe to our Scripps Health YouTube channel
and follow us on social media @ScrippsHealth.
I'm Susan Taylor, thanks for joining us.
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