When author Natalie Angier appeared as a guest on ABC television’s morning talk show, “The View,” producers asked her to cover the decidedly provocative topic of “everything you wanted to know about the vagina.”
Angier took the assignment seriously, which is not surprising for The New York Times science writer and Pulitzer Prize winner. During the show, standing beside an anatomical chart, she asked the youngest of the four women who are co-hosts of the show–each represents a different life phase–to locate the reproductive part most responsible for orgasm. The woman misidentified it, pointing to the urethra rather than the clitoris.
Embarrassing, yes. Unusual, not really.
Women of all ages are underinformed about their reproductive systems and bodies. Not that men are any better–research shows they’re even more clueless–but more to the point is the missed opportunity implied by knowing less.
The knowledge gap widens most when the subject is hormones.
Nearly two-thirds of women in a Yankelovich Partners survey said they did not know or weren’t sure about which hormones were involved in reproduction. The respondents were 40 and older, just the group you would expect to know more about estrogen and progesterone, which are both decreasing at that stage and might already be starting to cause missed periods or occasional hot flashes that signal the transition into menopause.
“There is such a dynamic interplay among the brain, ovaries and uterus,” said Dr. Elena M. Kamel, an obstetrician-gynecologist at Northwestern University Medical School. “Any woman who becomes more aware of how hormones affect her can significantly improve the quality of her life.”
For instance, a woman can figure out ways to feel happier or control appetite. She can better prepare to stave off a sports injury or the effects of aging. She can strengthen her cardiovascular system and reduce any current or future cellulite (well, maybe). Her sex life can bring more pleasure.
“The menstrual cycle is like having your own chemistry set,” said Angier, whose new book, “Woman: An Intimate Geography” (Houghton Mifflin, $25), positions her as an authoritative yet down-to-earth source about the biology of being female. “Over the years, I realized I could track my sexual desire and eroticism, pay attention to it, experiment over the monthly cycle. I know now when my sexual energy is on the ebb, and that mid-cycle is most intense for me.”
The word “hormone” comes from the Greek word horman, which means to excite, arouse or urge. Certain hormones, especially estrogen and progesterone for women, certainly do provide the biochemistry necessary for sexual arousal–no insignificant matter–and other heightened sensations. But researchers and other health practitioners are more excited about how these stimulating substances can regulate a woman’s body and affect her health and emotional state. There are dozens of hormones in all parts of the body.
Some examples of their impact:
– Scientists at Tufts University in Boston have found eating rapidly digestible simple carbohydrates such as potatoes or white-flour pasta might create a hormonal state that tricks the body into thinking it is still hungry. Decreasing intake of such carbohydrates, while adding fruits, vegetables and legumes, is suggested as a way to dial down the hormones.
– A growing number of sleep researchers believe a woman’s menstrual cycle can cause sleep disruption, especially in the final few days before menstruation when estrogen and progesterone dip to their lowest levels. What’s more, a study at Wayne State University in Detroit reported menopausal women who experience hot flashes have sleep disruptions every eight minutes during a night’s rest. Understanding such patterns can help women seek treatment from doctors and other health practitioners.
– The American Journal of Sports Medicine published a 1998 report that young female athletes suffer most of their serious knee injuries (especially tearing the anterior cruciate ligament, or ACL) when they are ovulating and estrogen levels are highest during the monthly cycle. Diligent stretching during this time can help protect a player’s knees.
– Pursuing a hypothesis that only years ago was dismissed by some scientists, the Mt. Sinai School of Medicine in New York was awarded an $8.5 million federal grant in June to study the possibility that decreasing levels of estrogen in a woman’s body during menopause affect brain functions such as memory, learning and attention. The landmark research extends its reach far beyond the changes in an aging woman’s reproductive system.
“We hope to gain greater insight on the driving force of these changes, whether menopause is driving brain function or if the aging brain is the catalyst for menopause,” said John H. Morrison, chief researcher for the Mt. Sinai project.
There is great interest in how the lesser amount of estrogen affects mood and emotions in later years.
“We are just beginning to scratch the surface of the body-mind connection and women’s feelings of subjective well-being around the time of menopause,” said Alice Dan, director of the Center for Research on Women and Gender at the University of Illinois-Chicago Medical Center.
– Estrogen keeps the blood vessels more pliable and free of plaque, making premenopausal women in their 30s and 40s less likely to suffer heart attacks as compared with men, who have estrogen in their bodies but at much lower levels. Another plus: Estrogen prompts the liver to make more high-density lipoprotein or HDL cholesterol, which is the good stuff that cleans artery walls. Research shows women’s risk of heart disease after menopause approaches the same percentage as men’s.
A good number of studies indicate hormone replacement therapy, using drugs with estrogen substances and progestin (which mimics progesterone), can help maintain good heart health. Yet at least one major report raises doubts about the issue. What’s more, there is an academic debate about whether hormone replacement therapy increases a woman’s risk of breast cancer.
The situation has a few more wrinkles: One is that estrogen replacement can be positive for bone density; one recent clinical trial even suggests some women with family histories of osteoporosis might benefit from taking certain drugs, such as raloxifene, even before menopause. Another is the possibility that estrogen replacement therapy staves off the aging of skin, especially holding off fine lines in the face.
– In a process that can only be classified as unfair, the typical woman gains 1.5 pounds of fat each year starting in her mid-30s as a counterbalance to her decline in estrogen. Debra Waterhouse, a registered dietitian and author of a new book, “Outsmarting the Midlife Fat Cell” (Hyperion, $12.95), contends the ongoing estrogen drop causes the fat cells in a woman’s body to produce more enzymes that are capable of replacing some of the estrogen naturally. As the ovaries and other glands and organs produce less estrogen, the fat cells become the most reliable source of estrogen. Problem is, those enzymes make the fat cells larger.
This new weight tends to settle around the waist (abdominal fat is optimal for manufacturing estrogen). Consequently, the thighs actually lose fat in some areas while other thigh cells may plump up because of estrogen adjustments. The result is cellulite.
Happily, Waterhouse doesn’t recommend any restrictive dieting during this hormonal shift that lasts from about 35 to 50. In fact, limiting calories might actually encourage the midlife fat cells to be even more industrious in a misdirected effort to “survive” on less food. Her top recommendation is regular exercise or physical activity. She also suggests a sensible eating plan, but does not hesitate to recommend women still eat their favorite foods in moderation.
– Women tend to produce less serotonin, a mood-regulating brain chemical, than men. It makes them more susceptible to any changes in serotonin levels, which are affected by the estrogen fluctuations inherent in a monthly cycle. Reduced levels of serotonin have been linked with depression.
“Women need to be savvy about their menstrual cycles,” Kamel said. “Somewhere in our educational system we haven’t stressed the basic concept of learning about human biology.”
The evidence strongly suggests that knowing is powerful. Studies using biofeedback techniques reveal that women who are more aware of their cycle are more able to control its effects by anticipating the changes. What’s more, some of the latest birth control formulations can help a woman tailor the medication to her individual sensitivities.
– Doctors and researchers are discovering hormone replacement therapy might be best prescribed case by case rather than by standard doses.
“There is a growing wealth of knowledge about estrogen and progesterone,” Kamel said. “One thing we have learned from clinical trials is a lower amount might be equally effective for some women.”
Other scientists are exploring whether hormone replacement therapy might be needed only for several years rather than decades–and if it might be most effective sooner rather than later.
“Maybe we wait until estrogen levels are too low,” Dan said. “It is an overly simplistic approach to what is a far more complicated matter than we used to think.”
In response to such complexity, manufacturers are in an ongoing race to develop non-estrogen products that are effective yet reduce the possible threat of increased breast cancer risk.
“The research has produced many more treatment options,” Kamel said. “Ten years ago, there were one to two products maximum. Now you see products incorporating wild yams, plant estrogens, oral medicines and time-release patches.”
WHAT ARE HORMONES AND HOW DO THEY WORK?
Chemists singled out the first known hormone in 1929, but women and men have been reacting to these bodily substances since ancient times. Hormones can be scientifically defined as substances secreted and moved through the blood and other bodily fluids to arouse tissue in other parts of the body.
Although there are dozens of hormones in a woman’s body, the ones that get the most attention are grouped under the umbrella term of estrogen. There are some 60 types of estrogen in the body–female and male–though estrone, estriol and, especially, estradiol are the most familiar.
Estradiol is the primary estrogen in premenopausal women and it works in tandem with progesterone to either help a woman get pregnant or stop the possibility each month.
Estriol is made predominantly in the placenta during pregnancy.
Estrone also is abundant in pregnant women, and easily detectable in urine, which caused scientists to seek out pregnant mares to develop synthetic versions of estrogen for such applications as birth control pills, fertility drugs and menopause treatments. One failure was the estrogen compound DES, which was used from the 1940s to 1960s for preventing miscarriage until it was found to cause cancer and birth defects.
Estrogen stimulates fat distribution, which results in a woman’s typically curvy shape. Both estrogen and progesterone are responsible for breast development, pubic hair growth and rapid height gains.
Hormones are produced and found in all sorts of glands and cells, including the pituitary gland (a hotbed of hormone activity that can stimulate other glands and affect organs), thymus gland (part of the immune system), adrenal gland (the body’s center for metabolism and stress reactions), pineal gland (controls our sleep and wake patterns through melatonin production), parathyroid gland (regulates calcium in the blood) and thyroid gland (our main gland for energy).
What’s more, hormones are hard at work in the kidneys (to produce red blood cells), intestines (helping digestion), ovaries (creating the monthly cycle), heart (controlling blood pressure), stomach (releasing digestive acids) and pancreas (insulin and glucagon regulate blood sugar levels).
HORMONES THROUGH THE AGES
Teens: Most girls now have their first menses between 10 and 14, compared with as late as 15 in past generations. African-American girls can experience puberty up to two years earlier than others, and girls tend to go through this significant hormonal change one to two years earlier than boys. The beginning of menses marks the reproductive years with the monthly release of the sex hormones, estrogen and progesterone.
20s: Typically the steadiest time for monthly cycles and a regular hormonal pattern, unless a woman is pregnant.
30s: Women might notice some unusual patterns of menstruation, most of which are stress-related. If there is any doubt about what was, say, once a normal 28-day cycle swinging longer or shorter in length each month, women should consult their gynecologists.
40s: Some women in their mid- to late 40s will begin to experience symptoms associated with menopause. The age range is estimated at 45 to 55.
In scientific terms, menopause means a woman’s ovaries stop responding to FSH (follicle-stimulating hormone). Consequently, less estrogen and progesterone are produced during the monthly cycle. The ovaries stop producing eggs and menstruation ends. Menopause actually occurs in just a few days, while the medical designation is 12 months without a period.
In everyday terms, this switch from premenopause to postmenopause marks what can be unpleasant or inconvenient changes, such as hot flashes, mood swings, night sweats and vaginal dryness. Hormonal flux is to blame. For example, when the ovaries fail to respond to the FSH, the pituitary gland produces even more FSH, which can lead to hot flashes.
50s: As menopause reaches the lives of most every woman, there are questions about whether to take hormone replacement therapy drugs. HRT protects against osteoporosis and heart disease but might increase the risk of breast cancer depending on the selected medications. In the past, HRT drugs were linked to uterine cancer. Researchers adjusted medications to eliminate the risk.
60s and older: Most side effects of menopause have passed. The major issues are whether decreased hormone levels might lead to osteoporosis or heart disease. Hormones are vital to bone strength and density, while cardiovascular researchers are finding new links between hormonal activity and heart protection.
Sources: American College of Physicians, American College of Obstetricians and Gynecologists, National Menopause Education Program, American Society for Reproductive Medicine.
