Debunking Five Myths About Hormones

Myth 1: PMS Doesn’t Exist

PMS is not a myth! PMS affects roughly 20-40% of women. Psychiatry and gynecology have developed distinct diagnoses. Symptoms of PMS develop in the luteal phase, which is the phase following ovulation. Ovulation typically occurs between day 12 to 14 of the menstrual cycle.  Symptoms of PMS are both psychiatric and physical, and they can develop at any time in a woman’s life, from the beginning of menstruation to menopause.  Women who experience at least one of the symptoms of PMS (listed below), which leads to significant impairment during the luteal phase and with resolution of the symptom occurring shortly after menstruation, can be diagnosed with premenstrual syndrome.

Symptoms:

• Angry outbursts
• Anxiety
• Confusion
• Irritability
• Social withdrawal
• Abdominal bloating
• Breast tenderness or swelling
• Headache
• Joint or muscle pain
• Swelling of extremities
• Weight gain

Symptoms must be relieved within four days of the onset of menses without recurrence until at least the 13th day of the cycle, and must be present in the absence of any pharmacologic therapy, hormone ingestion, or drug or alcohol use. Symptoms must occur reproducibly during two cycles of prospective recording. The patient must exhibit dysfunction in social, academic, or work performance. 

Myth 2: Menopause is a Sudden Transition

Menopause does not happen overnight. Hormonal changes begin to happen in the later years of menstruation.  In some women, these changes can begin in their 30s or 40s, before the onset of perimenopause or premenopause. In perimenopause we typically see a drop in estrogen, however, in some people, estrogen fluctuations can occur. There are two stages of peri-menopause. In the early menopausal transition stage, menstrual cycles are mostly regular and there are typically no noticeable symptoms. In the late transition stage, amenorrhea (not having a period) becomes more prolonged and lasts for at least 60 days up to the final menstrual period. Women may start to experience hot flashes, sleep disturbances and mood swings during the late transition stage. Menopause is formally diagnosed after one year of amenorrhea. The average age of menopause is between 45-51. The transition time to menopause usually lasts seven years but can last as long as 14.

Myth 3: Men Do Not Experience Menopause

It is not called menopause in men, but men do experience some of the hormonal changes we see in women that are related to aging. Men experience ‘andropause,’ which is associated with declining levels of testosterone related to the aging process. In a cross sectional analysis of men, it was found that free testosterone fell by 1.2% per year between ages 40 and 70 and sex hormone binding globulin (SHBG) increased by 1.2% per year which is associated with a further reduction of bioavailable testosterone. A screening scale called the ‘Aging Males Symptoms’ (AMS) questionnaire has been developed to assess testosterone decline and should a patient score high on this test, further lab tests to determine the level of testosterone decline can be ordered. Symptoms associated with andropause or declining testosterone are listed below:

• Gynecomastia, or breast enlargement
• Low libido
• Reduced muscle mass
• Lower bone density
• Increased body fat
• Low energy
• Lowered confidence
• Difficulty concentrating
• Insomnia
• Erectile dysfunction
• Depression sadness
• Low energy
• Infertility

Myth 4: Our Hormones Don’t Shift Until Middle Age

Most people think of hormonal changes as only happening at puberty and then again at middle age when women go through menopause and men andropause. Our hormones continue to change throughout life. We are all familiar with puberty which occurs between eight and 14 years of age. During puberty, hormones change the body from that of a child to an adult that is capable of reproduction. Hormonal changes continue to happen well beyond puberty into adulthood.

For both men and women hormonal changes through the 20s result in maximum muscle strength and bone mass being reached at this time. Prostate growth in men, which began in puberty, will also come to a halt during a man’s 20s. Women will see peak estrogen levels during their mid to late 20s and menstrual periods are typically regular. 

When men hit their 30s, testosterone levels will slowly start to decrease and women will start to experience fluctuating estrogen levels. Bone and muscle mass also begin to decline in both sexes. In a woman’s late 30s, periods can become irregular and fertility begins to decline, particularly after age 35. Some women may also begin to experience vaginal dryness and hot flashes due to changing levels of estrogen.

The impacts of decreasing testosterone become more visible in men in their 40s. One might notice fat accumulating in the belly or chest, declining height, increase in the size of the prostate, which can lead to issues with urination, and erectile dysfunction. This is the period of a man’s life that is referred to as andropause. Women in their 40s are beginning to enter perimenopause or menopause and will also notice greater bone loss, decreasing height, weight gain and irregular periods due to less estrogen production.

Hormones continue to change throughout our lives and though there are some undesirable symptoms associated with menopause and andropause, many of these can be mitigated by staying active, eating well and having healthy lifestyle habits. 

Myth 5: Estrogen is the Only Important Hormone for Women’s Health

Estrogen seems to get all the attention when it comes to women’s health. Estrogen is mainly produced in the ovaries, but is also produced in smaller quantities by the adrenal glands and fat cells. Estrogen is absolutely essential for reproduction and many other functions in a woman’s body; however, because there is so much focus on estrogen, the importance of progesterone and testosterone in women’s health is often overlooked.

Progesterone is also vital for reproduction and maintaining pregnancy. Progesterone is produced by the ovaries, adrenal glands and placenta during pregnancy. If progesterone levels are low, women may have troubles getting pregnant. Progesterone levels begin to increase during the second half of a woman’s menstrual cycle. Healthy progesterone levels are essential for preparing the uterine lining for implantation of a fertilized egg. Once implantation occurs, progesterone is then produced by the placenta to continue to maintain the uterine lining. If implantation does not occur, progesterone and estrogen levels drop and you get your period.  Progesterone compliments estrogen. If one has low levels of progesterone, then estrogen dominates and you might see symptoms like:

• Mood swings
• Low libido
• Heavy bleeding during periods
• Irregular menstrual cycles
• Breast tenderness

Testosterone is typically thought of as “the male hormone”, however, women do have testosterone and men do have estrogen. Testosterone plays an important role in fertility, sexual function, libido, menstruation, muscle and bone mass, and red blood cell production.  Interestingly, androgen receptors (testosterone receptors) are located in almost all tissues in women. Like in men, testosterone also declines with aging in women. Some of the symptoms experienced during menopause that can be potentially due to androgen deficiency are: anxiety, irritability, depression, lack of well-being, physical fatigue, bone loss, muscle loss, memory loss, insomnia, hot flashes, joint pain, breast pain, incontinence and sexual dysfunction. 

As has been discussed, women need to consider more than just estrogen when it comes to healthy hormone levels. A deficiency in testosterone or progesterone can equally impact a woman’s health, at any time in her life. 

Sources:

• Glaser, R., & Dimitrakakis, C. (2013). Testosterone therapy in women: myths and misconceptions. Maturitas, 74(3), 230–234. https://doi.org/10.1016/j.maturitas.2013.01.003
• Hofmeister, S., & Bodden, S. (2016). Premenstrual Syndrome and Premenstrual Dysphoric Disorder. American family physician, 94(3), 236–240.
• Nandy, P. R., Singh, D. V., Madhusoodanan, P., & Sandhu, A. S. (2008). Male Andropause : A Myth or Reality. Medical journal, Armed Forces India, 64(3), 244–249. https://doi.org/10.1016/S0377-1237(08)80105-0
• Nunex, Kristen. (2020, June 11) .“What is Second Puberty?” Healthline. https://www.healthline.com/health/second-puberty