In the past several columns, we have explored how parents can lift the mood of themselves and their children. The physical and psychological methods we've presented have been shown to be effective, but of course, this column is no substitute for professional advice. If your mood is seriously depressed or unstable, you should immediately consult with a licensed health professional.
Last week, we explained how good nutrition can make a major difference to your mood, and here we discuss the role three key hormones play with a mother's mood -- and what you can do about it.
Waltzing hormones
Rather like a family sometimes, all the parts of the body have to be told
what to do in order to meet the ever-changing demands of life. There are two
main types of substances that do this: neurotransmitters and hormones.
Neurotransmitters send instructions from nerve cell to nerve cell, while hormones send instructions from endocrine glands to targets throughout the body. Sometimes the destination of a hormone is the brain itself. As a result, hormones affect memory, self-control, and that moment-to-moment coloring of life that we call mood.
And sometimes the target organ is another endocrine gland, so hormones affect each other in intricate feedback loops of extraordinary complexity and dynamism, like dancers at a waltz moving through familiar patterns while also reacting to each other over time. Science is learning more every day about our hormones, but there is still a lot that is not yet understood about this marvelous system.
Thyroid, progesterone and estrogen
In this article we will focus on the three hormones -- thyroid,
progesterone, and estrogen -- that probably make the most difference to a
mother's mood. (Of course, other hormones also affect how you feel,
particularly the adrenal hormones, and you should ask your doctor if you
have any questions about these.)
Early in pregnancy many women feel some nausea, a side effect of the dramatic rise in progesterone and estrogen needed to make a good nest for a baby within a mother's body. Then women often feel happier than usual -- and maybe more emotional as well. Jan remembers pregnant days of crying in the car with happiness while listening to John Denver songs.
Then, out comes the baby -- and progesterone and estrogen crash, dropping to a hundredth or a thousandth of their previous levels within a few days. This leads to weepy moments, everything seems socomplex, life sometimes feels like being caught in the rinse cycle of the washer. Most mothers recover in a week or two from the "baby blues," but progesterone and estrogen levels may have landed somewhere other than their optimal spot in their rushed descent from the high sky of pregnancy. (Additionally, mothers enter the breastfeeding fog of prolactin, the nursing hormone -- What did I come into this room for? -- but that's another story.)
Meanwhile, thyroid hormone is controlling the fundamental energy thermostat of the body, the rate at which metabolic activities happen. For reasons that are not yet entirely clear, the thyroid gland of many mothers seems to be vulnerable during postpartum period. One possibility is that the immune system -- which has to be "turned off" in certain ways in order not to attack the developing fetus (whose DNA is different in some ways from the mother's) -- may go to the other extreme in some cases when it is "turned on" after childbirth and starts attacking the thyroid gland in an auto-immune reaction. (Thanks to Richard Shames, MD, a holistic physician and authority on thyroid, for this information.)
Whatever the source,
disturbance in thyroid is thought by many researchers to be often implicated
in postpartum depression, even after the most intense symptoms have cleared
up after six to twelve months, a low-grade deficiency in thyroid may still
linger.
And of course a new friend has moved into the mother's home: STRESS. The
ongoing stress of everything from sleep disturbance to quarrels with her
partner cause the sex hormones (including progesterone and estrogen) to drop
and disturb thyroid as well.
When the balance goes awry
Although the complexity of hormonal interaction can make it difficult to
point to a single hormone as the culprit, following are some symptoms that
might indicate certain hormonal imbalances:
- Low thyroid -- Fatigue; feeling of chilliness; dry skin; hair loss (but
hair loss in the postpartum period may also be a normal side effect);
depressive feelings
- High thyroid -- Hyperactivity; heart palpitations; feeling hot; anxiety
- Low progesterone -- Marked premenstrual symptoms of irritability, water
retention, breast tenderness; depressive feelings.
- Low estrogen -- Hot flashes; vaginal dryness; depressive feelings.
Assessment
Because hormones are so intensively taxed during pregnancy and immediately
thereafter, and because they have far-reaching effects on the brain, a
mother who is experiencing low mood should consider having her hormones
assessed, especially if there are other signs of hormone imbalance, or if
symptoms are routinely worse at a particular point in the menstrual cycle.
Assessment is not treatment, and it cannot possibly harm your health
(although your finances may feel a little injured).
And if you do find something amiss, correction can begin early, when it can do the most good. There are various ways to assess your hormones.
Thyroid
Thyroid testing is most commonly done through blood tests that
measure the two thyroid hormones, T4 and T3 -- plus thyroid stimulating
hormone (TSH), which tells the thyroid gland to pump out more thyroid. High
TSH is a sign that thyroid levels are low enough that the body's feedback
mechanisms are calling for more. Low TSH means that there is too much
thyroid hormone, so the thyroid gland is being asked to cut back.
The levels of TSH are generally considered more informative than those of T3 or T4. Some physicians think that blood tests are not adequately sensitive. They utilize a urine test that provides an indication of the amount of thyroid actually used by the body. These doctors believe that the results of urine testing correspond more reliably to symptoms of low thyroid.
Because thyroid regulates our metabolic rate, the basal body temperature can be used to infer thyroid levels. You can test yours at home for the cost of a thermometer. Basal body temperature is another important source of information about thyroid levels, and it can be used as an indication for further testing.
Progesterone and estrogen
When these hormones are tested in the blood, it
is important to measure them at the right time of the menstrual cycle.
Progesterone is usually checked three to five days before your period
begins, when it is at it peak. Estrogen has two peaks during the menstrual
cycle, and your physician will tell you when to measure it.
Progesterone and estrogen may also be tested in the saliva, which is thought by some practitioners to be a more sensitive measure of the hormones that are actually available for use by the body. Saliva testing is easy and relatively inexpensive, and there are panels available from some medical labs that allow you to test your hormones over your entire menstrual cycle by taking a sample every three days. This can provide a very clear picture of your hormonal rhythms over time.
Finally, basal body temperature can also indicate the status of progesterone. (See below)
Interventions
Our discussion of what you can do to remedy hormonal problems focuses on low
levels, since those are more common.
The goals of intervention
Hormones are transported by the blood like
messages in bottles sent to distant islands. Once they arrive, they slip
into special biochemical sites called receptors and deliver their signal. As
with any communication, difficulties can arise with the sender or the
receiver. Sender problems include not enough "bottles" or poor signaling to
release them into the bloodstream. Receiver problems include receptor sites
that are too few in number or blocked. Successful interventions help an
endocrine gland and its target organs "talk" with each other more
effectively.
Hormone supplementation
Conventional medicine will often supplement
hormones when they are low. This can be very effective -- sometimes,
literally a lifesaver -- but there are also potential drawbacks. When some
hormones are supplemented, such as thyroid, the body can "turn off" that
gland so you need to take thyroid as a medicine for the rest of your life.
There are also risks with certain protocols, such as hormone replacement
therapy (HRT) for women in menopause, that need to be weighed thoughtfully
against the possible benefits.
If you and your physician decide to supplement hormones, several options are available, depending on the hormone. Thyroid is available only by prescription. It comes in the form of either a natural extract of the thyroid gland of cows or pigs, or as a synthetic product; some professionals consider thyroid extract to be more effectively used by the body.
Progesterone is available in several forms. In What Your Doctor May Not Tell You About Menopause, John Lee, MD, has written about natural progesterone made by extracting certain substances from plants (often wild yams or soybeans), and then converting them to progesterone in the laboratory. What is "natural" about the result is that it is identical to the progesterone found in your body.
Progestins (available by prescription) are progesterone-like products, similar to but not identical to progesterone. These are promoted by the pharmaceutical companies that have been able to patent them. Because they do not naturally appear within the body, progestins may have side effects for some individuals that natural progesterone does not have.
Various creams containing natural progesterone are available in health food stores, along with other hormones such as DHEA, melatonin and cortisol. But just because something is "natural" or available over-the-counter does not mean it is harmless to use indiscriminately. Hormones are powerful substances, and we recommend that you always consult with a licensed health practitioner about their use.
Holistic interventions
This approach can be less potent than hormone
supplementation and less researched (since there is little economic interest
in spending money on studies of materials that cannot be patented), but it
has some advantages as well. These methods aim at correcting the underlying
source of endocrine problems by providing more of the building blocks and
catalytic co-factors used to make hormones or by increasing receptor sites.
And they emphasize balance of the entire endocrine system. Several holistic interventions are discussed just below.
Nutrition
A diet high in protein and unrefined carbohydrates, and low in
sugar (sorry), is a good base for hormonal health. A high potency
multivitamin and mineral is an excellent support to make sure you're getting
all of the nutrients and co-factors you need. Additionally, the following
suggestions may be useful:
Chinese medicine
Both acupuncture and herbs can have well-established
benefits for the endocrine system. Sometimes herbal formulas are given at
different times in your menstrual cycle to boost specific deficiencies.
Acupuncturists can be found through referral or even looking in the Yellow
Pages.
Western herbs
Various Western herbs are known to effect hormones, and these
are usually available at your health food store. Black cohosh, red clover,
siberian ginseng, and licorice have all shown estrogenic effects. Another
herb, vitex, has been shown to have a balancing effect on estrogen and
progesterone.
Homeopathy
This method involves consuming sugar pills coated with purified
water containing a tincture of various substances that has been diluted so
many times that literally not a single molecule of the original material can
possibly remain. For reasons that no one knows for sure, homeopathic
treatment sometimes seems to have remarkable results. Homeopaths are listed
in the Yellow Pages. Ifeoma Ikenze, MD, in San Anselmo, California, has
written the book, Menopause and Homeopathy, which contains much information
relevant to hormones.
Psychosocial
Of course, one of the most direct ways to affect your hormones
is to lower your stress levels. You can do this by altering your
circumstances (such as maybe more childcare), getting support (perhaps join
a mothers' club), or changing your reactions (such as through exercise,
meditation, or developing more insight into why certain things upset you so
much).
Taking your basal body temperature
The right thermometer. Basal body temperature is your resting temperature
without the influence of activity. To measure it, you will need a highly
accurate "basal" thermometer with two-tenths-of-a-degree increments between
97 and 100 degrees; mercury is best, and you may have to check a few
pharmacies to obtain a proper thermometer.
Taking your temperature
Shake down the thermometer before you go to bed and
put it next to you on a bedside table. When you awaken in the morning, put
the thermometer in the middle of your armpit with as little movement as
possible and lower your arm. Leave it there for 10 minutes, resting as
deeply as possible. Then remove the thermometer and record the reading. For
maximum precision, take your basal body temperature for three to five days
and chart all of the results.
Checking thyroid
For thyroid, do this test during your menstrual period,
while progesterone and estrogen are relatively low; if you are in menopause
you can do it at any time. The ideal reading is between 97.8 and 98.2 (the
familiar temperature of 98.6 is an orally-measured temperature we have when
we are active). The further above or below that range you are, the more
likely it is that thyroid is out of balance. If your temperature is
four-tenths or more out of range, we encourage you to discuss further
testing with your physician.
Checking progesterone
For this hormone, you need to take your basal body
temperature throughout your menstrual cycle and chart it. The sign of
progesterone is an increase of a few tenths of a degree at the middle of
your cycle when you ovulate. Your temperature should stay at this slightly
higher level until just before your period begins. If you do not find this
rise in temperature, further evaluation of your progesterone could be
useful.
