There Really Might be Something Wrong With Your Hormones

As a practicing ob/gyn for nearly 25 years, I spent my professional lifetime taking care of women, giving information and educating my patients about all manner of things to do with their health.  I truly loved my job.  The relationships I developed with patients over the years were unbelievable, and I would like to think over the decades I was in practice that I was making a difference in the lives of women.  But in the last decade or so, there was this one persistent complaint that I started to get over and over again, and I admit that I struggled to give these patients an answer.  

I can’t tell you how many times a patient would say to me “there’s something wrong with my hormones”.  Undeniably, the majority of the time, the patient was in her 40 -50s and perimenopausal, so she assumed something was wrong with her ovaries.  In addition to complaining about hot flashes, she would go on to list a litany of other symptoms- irritability, depression, brain fog, poor sleep, bloating and weight gain.  Weight gain that was happening despite the same amount of calories and exercise as always. I tried my best to be empathetic, but I also knew that there wasn’t anything “wrong” with her ovaries.

“Menopause is inevitable, and is sort of like puberty, but in reverse” I would say, and I would give lots of advice on exercise, and nutrition, and even prescribe things like anti-depressants or hormone replacement therapy to some patients.  And I would spend time educating these patients on the decreased production of  estrogen and progesterone at this time of life, and explain that this was just a transition.  And if  I am really honest, I will admit that for much of my career I didn’t really understand what they were feeling, and I didn’t really know what to tell them that they hadn’t already heard.

Although women have been going through menopause forever, the truth is that this latest generation is significantly less healthy, and with more burden of chronic disease, so was that making it harder? 

But that was before I went through menopause myself (and I totally get it now), and before I dove down the rabbit hole of lifestyle medicine and started learning about things like the microbiome, and why ultra processed food is so bad for us.  I’m guessing you’ve heard of the microbiome, I know I certainly had, but it wasn’t until now that I really started to put the pieces together, to understand just how important it is, and how it relates to so many aspects of our health. 

And while most of us can understand that a diet of Oreos and Cheetos will do our waistline no favors and is simply not healthy for us, we don’t realize that the so called “organic” or “ whole grain” 100 calorie snack packs we are choosing in attempts to be healthy are just as bad for us.  There has been a creeping normalcy of food processing since the 1970s and these so-called nutritional, ultra processed diet foods are decimating our microbial defenses. 

This destruction of our internal ecosystem has led to a tsunami of chronic disease in women, manifesting in a myriad of symptoms that we brush off as hormonal.  In addition to the worsening brain fog, irritability and bloat that make us not feel well, the dramatic increases in pre-eclampsia, obesity, poly cystic ovarian syndrome, infertility, and  endometrial cancer are just a smattering of the gynecologic diagnoses that are driven by factors in our diets and lifestyle that do affect our hormones. 

In order for you to understand these connections, we need to talk first about our gut microbes, and then second define what constitutes ultra processed food.

Although the concept of bacteria living in and on us has been described for > 150 years, our knowledge of their function is still in its infancy. Amazingly, it is really only in the last 10-20 years that scientists are beginning to identify just how many species there are and what they do, as it was only in 2006  that a scientific breakthrough allowed many of them to be grown in culture, and scientists could begin to identify them.  Previous to this, the majority of microbes within us were essentially invisible.  And unfortunately, I, like most practicing physicians, knew almost nothing about it because of the significant lag time for scientific research to make its way into clinical practice.  

We have thriving colonies of microbes all over our body, but some of the most important ones are in our mouth, our GI system (the gut), our vagina, and on our skin. Currently it is believed that microbial cells exist in the human body in approximately a 1:1 ratio with human cells.  They are made up of bacteria, viruses, fungi and a relative newcomer known as archae (unicellular organisms known as extremophiles for their ability to thrive in extreme environments like hot springs and salt lakes). 

The largest, and seemingly most important collection is in the gut, estimated at 39 trillion microbes, which is 100x more than there are stars in the sky.   And while we know that the recently sequenced human genome carries some 22,000 protein-coding genes, researchers estimate that the human microbiome (the amount of DNA contained in all of the microbial species within us) contributes some 8 million unique protein-coding genes, or 360 times more bacterial genes than human genes.  According to Dr Will Bulsiewicz MD, MCSI, and author of the amazing book Fiber Fueled  we are only 1% human, as 99% of our DNA comes from microbes.

There is an explosion of research showing that these microbes not only co-exist within us, but in fact, we have evolved to rely on them to play a crucial role in our health and longevity.  And this is a huge culture shift for the medical community and all of us who have grown up in the age of antibiotics where we have been taught to think that all bacteria are bad.  While we are learning that the majority of the trillions of microbes that live in and on us are actually beneficial, producing chemicals that are necessary for our survival, the pathogenic, or harmful ones are there too. 

For most people, most of the time, the good microbes outweigh the bad ones.  This is known as eubiosis.  But when they are out of balance, known as dysbiosis, we will suffer the consequences, as these pathogenic bacteria can cause us harm. 

As women, we know that there are “good gal” microbes, namely lactobacillus bacteria, that live in our vagina and keep it healthy.  However there are “bad gals” in there as well, such as candida and gardnerella.  The good and the bad live side by side, but typically the lactobacillus colony predominates, and actually creates a mild acidic environment that makes it inhospitable for the others to really thrive.  But, when the pH balance shifts, you can get a painful, itchy, or malodorous yeast or BV infection as the bad gals take over.

Typically the treatment involves not only some antifungal or antibiotic cream to quell the invasion, but also a restoration of the lactobacillus colony, to restore the acidic environment.  It is the restoration of the vaginal ecosystem that ultimately fixes the problem, as your vaginal microbes come back into balance and become eubiotic again. Despite my degree and ability to write prescriptions, it is not the vaginal creams and pills I dispense that fix the problem; they merely alleviate the symptoms.  I have treated many women over my career that struggle to regain this balance, and instead end up with chronic vaginitis infections.  

What I failed to know as a gynecologist all these years was just how important the collection of gut microbiota is.  Different from the vagina, where lactobacillus is queen, in the gut, diversity of species is key.   Each of the microbial species in our gut plays a different role, and remarkably we have evolved to depend on them. 

It is well documented and studied that the microbes living in our gut actually assist us in digesting our food.   “Humans don’t have all the enzymes we need to digest our own diet,” said Lita Proctor, Ph.D. the Human Microbiome Project program manager at the National Human Genome Research Institute. “Microbes in the gut break down many of the proteins, lipids and carbohydrates in our diet into nutrients that we can then absorb.”  But the truth is, anything you put in your mouth will be processed by these microbes, and a lot of what we are eating is simply not food, for us, or for them.

Dr Proctor goes on to state “when our gut microbes are healthy and in balance,  the microbes produce beneficial compounds, like vitamins and anti-inflammatories that our genome cannot produce.” Thus the human gut microbes also support the immune system’s function, as anti-inflammatories are compounds that regulate some of the immune system’s response to disease. 

We now also know that it is related to key components necessary for cognitive functioning, and involved in controlling your metabolism and your reproductive health by directly influencing your hormone levels as well.  

And similar to the vagina, there are good microbes and  bad microbes in your gut.  In general, the good should outnumber the bad, and in healthy individuals, the pathogens do not cause disease, they simply co-exist.  However, when the balance shifts, the bad microbes can take over, and this can have significant consequences for you that are not as obvious as an itchy vaginal discharge. 

Instead, these pathogenic microbes take over and produce chemicals that are harmful and ultimately lead to the development of many chronic diseases.  The larger question is really trying to understand how and why some patients become dysbiotic, or what allows the pathogenic species to take over and wreak havoc.

Although no two humans are alike, our human genomes (ie our genetic material) are remarkably similar.  According to the NIH, our genes are virtually identical 99.9 % of the time, meaning that the vast diversity we see in human traits comes down to the mere 0.1% difference in our genes!  But our microbiomes can be as much as 90% different from one person to the next.  In fact, your gut microbiome is felt to be as unique as your fingerprint.

There is enormous variety in the species that can exist within you, and this is determined by many factors, such as the type of food you eat, where you live, whether or not you are on antibiotics, as well as genetics, and age.  

And we are now learning that it is these 2 factors – the balance of good vs bad microbial species, and the variability in the microbiome from one person to the next, that seems to be the driving force for the explosion in the development of many chronic diseases that we are facing today.  There is mounting evidence that the degree of dysbiosis a person has is a strong predictor of disease across that individual’s lifespan. 

There is also a ton of new evidence suggesting that there are many bi-directional relationships between the microbes in your gut and your hormone levels, specifically those that control your appetite and weight.  Meaning that eating certain foods can create dysbiosis, and then these pathogenic species of bacteria can influence your hormones and cause you to not only gain weight, but to crave more of the things that the pathogenic bacteria thrive on, but to your detriment. 

Additionally, there is evidence that your gut microbes can influence your estrogen levels across your lifespan as well, which can impact many of the symptoms women feel throughout their menstrual life and into the menopausal transition.  I feel like I am finally gaining the knowledge to answer that persistent question, and that for many women, there really is something wrong with their hormones.

Stay tuned for the remainder of the posts in this series that will dive deeper into some of the science to highlight the functions of the gut microbiota, how we are inadvertently killing them on a daily basis, what you can do to promote optimal gut balance, and why as women we  should care about more than lactobacillus.