From menopause to your menstrual cycle, perimenopause to a new study on the side-effects of HRT, here's how to stop your hormones sabotaging your fitness goals, energy levels and skin
Are you at the mercy of your hormones? From mood swings to dwindling energy levels, adult acne to a fluctuating waistline, our body’s inner workings could be having a more profound effect on our weight loss goals and wellbeing than we thought possible.
Treating the unpleasant symptoms can be a confusing state of affairs: what really works in terms of products and can hormone replacement therapy (HRT) cause more harm than good for instance? However, with a recent study conducted by New York University suggesting that the serious side-effects of HRT have been overstated, the number of options available to us could now be wider than ever. The study which involved taking full-body scans of 80 women on HRT every year for 10 years revealed that women who took HRT for up to 25 years were no more likely to develop breast cancer, heart disease or diabetes. NHS watchdog Nice are also set to publish new advice in the coming month.
In the meantime though, we asked a trio of Get The Gloss Experts for their expertise when it comes to understanding how our hormones affect our bodies and minds at key stages in our lives and more importantly, how to prevent them from taking over...
Your fitness levels and weight loss goals
Fitness trainer and exercise expert Jane Wake helps to explain the link between hormones and exercise
Hormones can have a significant effect on our bodies. One factor many of us are not aware of is how, at different times in our cycle, hormones can affect our fitness and/or ability to train in particular - here's how they work against your workouts at key life stages:
Pre-menstrual and pregnancy
If you are in your 20s, 30s and have no kids, then commonly your monthly cycle will be your biggest hormonal indicator when it comes to your fitness. The hormones progesterone and estrogen for example rise when you are pre-menstrual. Research done on female athletes with knee injuries has demonstrated that there is a significantly higher incident of injury during this stage.
It’s commonly known that the hormone relaxin, which surges in women during pregnancy, causes joints to release and become unstable. What's less known is that progesterone can have the same effect and while this is not nearly as high an effect as that experienced by women during pregnancy, if you train a lot, you are undoubtedly more susceptible.
So if you then consider the effect of just a little spike in your hormone levels when you are premenstrual and how this can affect your mood and your physicality (it can also make you feel a little clumsy and disoriented), consider the fact that during pregnancy the level of these hormones can increase by as much as 300%! So it’s no wonder we cry at the littlest thing or find moving can be painful and awkward. Exercise however can be the best thing to counteract all of this; it’s about finding the right exercise though and making sure you get proper advice from an expert.
Postnatally, our hormones can go all over the place! Many women have thyroid issues after pregnancy – the thyroid gland secretes hormones that regulate our metabolism and can be either underactive (hypo) or overactive (hyper). Your body is no different to the construction of a house - it needs sound foundations and a supporting framework. Pregnancy is like having a hurricane, flood and fire all at once! Again exercise can do huge amounts for helping us to regulate all of this.
Perimenopause and menopause
As you move into your late 30s, 40s and 50s, estrogen levels can start to lower – and I say 30s as I am finding more and more women hitting the perimenopausal stage in their 30s as well as their 40s which has some big big consequences for many of us. This affects us physically in two major ways:
1. Because of the reduction in estrogen, our bodies do this amazing thing of trying to create more. Fat cells around the abdomen are particularly good at producing estrogen so hey presto - we get this extra layer of fat around our middles! It’s Mother Nature's way of saying, “Hold onto the abdominal fat – it’s gonna help your hormone levels!” This could have serious health implications as abdominal fat is also the most dangerous kind of fat for your vital organs. Being too thin however, can be just as dangerous to your health - estrogen is a bone protector and higher levels help to keep your bones strong. In essence, being overweight or too thin is not good – being lean and very strong however can be a big bonus.
2. 1 in 3 women from age 50 suffer from osteoporosis and 50% of us will suffer a bone fracture due to bone thinning in our post-menopausal years. By the time we are around 25, our bone density is pretty much set which is why we should be encouraging girls/teenagers to eat and exercise the right way to promote better bone health. But here's the big thing – the only way you can continue to protect yourself, through your late 20s, 30s, 40s, 50s, 60s, 70s and 80s(!) is through exercise which is why, whatever age you are, it’s never too late to start.
Best exercise practices
Do higher intensity/loading exercise (i.e. resistance exercise): This will help to release feel-good hormones as well as help to create better strength and metabolic changes that keep hormones on more of an even keel.
It’s also better for your PMS - helping to release the feel good hormones called endorphins. You need to ensure that higher intensity exercise however doesn't over stress your body which can lead to higher levels of adrenaline and cortisol which can affect sleep patterns and also affect your ability to lose weight - you need to feel strong but very much in control. The fitter and stronger you are, the more you can go for it and the more you can benefit, but you need to build up to it gradually with a progressive programme of 2 – 5 times a week doing both interval style training and resistance work. Don't therefore go straight from nothing into bootcamp – positive stress to the body can so easily turn into negative stress and whether it’s your body fat or injury or both you want to keep at bay, then you need to build it steadily.
Do proper core training: You need good balance and stability and you need a good teacher to teach it to you correctly - planks and crunches are not where it’s at. I'm talking refined movement that considers inner muscles you never knew you had.
Help to balance this out with calming lengthening exercise: I practice Pilates Flow 2-3 times a week which combines yoga, Pilates and martial arts. It's great for developing strength, balance and power, trains your core effectively but is also incredibly calming and really complements high intensity exercise.
Moderation: If you are pregnant or trying to conceive or are very recently postnatal, skip the high intensity stuff and keep yourself regularly active at more moderate levels. The key is to try and get yourself as fit as you can before you conceive, then continue to train but switch your focus to more moderate cardio and specific prenatal or postnatal core training. My company Baby-A-Wake is a complete programme that can help you through this period with specific exercises that builds you up to really fit levels while pregnant and postnatal, but done in the right way.
Load your bones with impact activity but don’t leave any areas out! Female tennis players are shown to have incredible bone density in their serving arm but dramatically decreased density in their non-serving arm. Don’t just work one area, get into a full body programme where no muscle is left unworked!
If your metabolism is all over the shop because you are postnatal, perimenopausal or menopausal, remember that all of the above exercises are the one thing that could help you. With every 1lb of increased muscle mass, you can burn an additional 50 calories per day – doesn’t sound a lot in a day but multiply that over a year and that equates to 18,250 calories which is the equivalent of keeping 5lbs of fat at bay per year. Put that in reverse and by NOT adding a 1lb of lean muscle, you could be putting on 5lbs of fat each and every year.
Keep generally moving: Particularly in your perimenopausal and menopausal years. Every bit of movement helps and research shows that people who are generally moderately active most days of the week are far better able to control weight and reduce injury and health factors. So think twice before you jump in the car or grab a cab – could you just walk it instead?
Find something you love: So what I'm saying is we really do have to exercise but that's not going to happen to all of us if we keep chasing modes of exercise that we actually can’t stand. Therefore, my final tip is to find something that rocks your boat - I don’t care what it is and neither should you, just make sure it continues to challenge your strength, your breathing and your ability to stay happy and calm. All the things that an imbalance of hormones hates!
Dr Stefanie Williams, Dermatologist and Medical Director at European Dermatology London reveals your hormones' effects on your skin...
There is a close connection between our hormones and our skin. The most evident sign for this is the typical flare-up many female acne sufferers experience just before or during menstruation.
At this time of the month, women often observe the development of pimples and spots, caused by a change in the levels and ratios of sex hormones in our body. Women also have male hormones such as testosterone in their bodies, albeit at much lower levels. If the effects of these male hormones become overbearing this can lead to acne flare-ups.
Will The Pill help?
For the above reason, certain contraceptive pills have ‘anti-androgenic’ effects, i.e. to reduce some of the unwanted effects of male hormones. Although certain contraceptive pills can have positive effects on women with a tendency for acne, as a dermatologist I don’t usually recommend starting the contraceptive pill as a way of controlling your acne. If you are taking them for their contraceptive purpose, then of course make sure your GP selects one which also has anti-androgenic effects if possible.
However, if the contraceptive effect is not what you are after primarily, then there are better options to control your acne - some of which even have the ability to switch off acne for good. Make an appointment with your dermatologist to find out more.
Acne flare-ups are not the only unwanted sign of changes in sex hormones. In the long-term, this group of hormones also influences our skin’s firmness and elasticity. During menopause, the levels of estrogen and progesterone decline, leading to a loss of collagen in our skin.
Collagen is our main structural skin protein; it’s situated in the crucial middle layer of our skin – the dermis. With declining collagen levels in the dermis, our skin becomes visibly less firm and develops more lines, wrinkles and sagginess over time. Studies have reported an astonishing loss of up to 30% of our skin’s collagen content within the first 5 years after menopause!
Cortisol’s effect on your complexion
While sex hormones are the most well-known types of hormones, there are many other hormones that influence on our skin. For example, when we feel chronically stressed the level of cortisol (one of our major stress hormones) remains high throughout the day. Cortisol is sometimes referred to as the ‘death hormone.’ Normally cortisol levels are high in the morning just after waking up (to get us ready to face the day!), but then go down throughout the day. However stress can lead to persistently high levels of cortisol. Studies have shown that cortisol levels are connected to not only how long we are likely to live (centenarians tend to have lower levels of cortisol), but also to how old our face looks!
Another hormone is insulin, which is often referred to as the ‘master hormone.’ Insulin regulates our blood sugar levels. Type 2 diabetes is caused by insulin resistance, leading to elevated blood sugar levels with all its negative consequences. Also, if we eat a lot of sugary foods and foods high in processed carbohydrates, our blood sugar levels go up as a response to our insulin level. High blood sugar and insulin levels lead to micro-inflammation in the skin and premature skin ageing.
We know from studies that HRT (hormone replacement therapy) can mitigate some of the negative effects of menopause on our skin quality. Generally speaking, the skin of women who are on HRT ages ‘better’ than that of women without a ‘helping hand.’ Having said that, I would not recommend taking HRT solely to slow down your skin’s ageing process. HRT influences our entire body and there are a variety of pros and cons that need to be taken into careful consideration before deciding for or against HRT. The best thing is to discuss this with your GP or gynaecologist when the time comes.
There are certain over-the-counter remedies such as red clover extracts, which are said to help with balancing the hormonal changes that come with menopause. Although they have been reported as helpful for menopausal symptoms such as flushing, to my knowledge there are not well controlled clinical studies to investigate whether long-term supplementation has positive effects on our skin quality. Another interesting study looked at supplementation with melatonin, our ‘sleep hormone’ (and a powerful antioxidant) and it has been reported that taking melatonin might have the potential to delay menopause – to an extent. I would be interested to see further studies on this.
In the meantime, what I often prescribe for my female patients who are entering the menopause without HRT and are concerned about their skin quality, are topical prescription creams with low levels of estrogen, progesterone and melatonin. These are tailor-mixed to each patient in a specialist pharmacy. Due to the very low levels of sex hormones, these creams work only in the skin without systemic effects.
Mood and energy levels
Doctor and sexual health specialist Dr Jan Toledano explains how hormones can cause dramatic changes in our general mood
Hormones are integral to mood and when our hormones are out of balance, it can lead to depression, anxiety, lack of confidence, poor sleep and tiredness, having a huge knock-on effect on our lives.
It should be noted though that hormones are not the only reason we suffer from low mood or energy but if we seek to balance them out, we’ll have the best chance of feeling the best we can.
During late 20s, 30s and 40s, the main problems experienced tend to be due to fluctuations in the menstrual cycle. PMS in particular can lead to low mood, anxiety and low energy. The hormonal cause for this is due to high levels of estrogen and low levels of progesterone. Progesterone is the‘happy hormone’ and replacing it can help in easing pre-menopausal symptoms - mood and energy being two of the key ones.
This is a time when you can suffer from huge hormonal changes. Some women feel great and some less so. Hormonal manipulation isn’t an option at this time, so good nutrition and exercise become particularly important factors at this stage.
Post-natal depression is particularly common and can be mild or very severe depending on the person. It coincides with the huge drop in hormone levels that happens after pregnancy - restoring the hormones lost is the best way of treating it. Recognition is key. Often women will be offered anti-depressants by their GPs however I’ve found that women respond particularly well to progesterone as it restores its levels and helps reverse depression almost immediately.
In some women, perimenopause is associated with very noticeable changes in mood ranging from extreme anxiety to low mood. From a hormonal perspective, this is due to fluctuating estrogen levels in the context of low progesterone. Again, the best way to tackle this would be by replacing the progesterone to help restore mood without the need for anti-depressants.
Some women can experience profound depression and anxiety. This can be attributed to other factors, with mood changes reflecting what they are going through generally during this difficult time.
During the menopause only a small amount of testosterone is produced and can result in low energy levels. The hormone DHEA is also very important for energy and vitality. It’s produced in the adrenal gland, but as we age we produce less and less of it.
The symptoms of low testosterone can manifest themselves additionally in lower cognitive activity, strength and libido.
How to better your mood
Good nutrition and exercise are extremely important as they can boost the body’s ability to balance its hormones to a certain degree. A diet that is high in sugar and processed foods can exacerbate pre-menstrual symptoms for example so it’s important to get this right first.
Reducing sugar is very important, as is having a diet that is rich in protein and healthy fats such as those found in olive oil, nuts and hummus etc. as they help maintain blood sugar levels. One also has to think about other inflammatory foods too. Everyone is different, but there are some foods which can exacerbate PMS - for some it might be a lot of dairy, others a lot of wheat for example.
There comes a stage though, (in particular at the pre-menopausal stage where you’re more sensitive to low progesterone), where you can no longer boost your hormones in this way. At some point, you may need to replace hormones with an equivalent of that which you are not producing enough of any more - this is where we come in with regards to fixing the underlying problem regarding the supply of the hormones that are now no longer being replaced.
How to increase your energy levels
The best way to remedy this comes down to making sure enough estrogen and progesterone are present in the right amounts and good nutrition. The preferred way to take hormones is through the bloodstream. Creams used on the skin are very effective as are intrabuccal lozenges, i.e. those that are taken via the mouth.
These are the two best methods as they don’t need to go through the gut or liver. The problem with ingestion through the gut is that they get broken down and so higher doses are needed for them to work. Creams allow the hormones to go straight into the bloodstream and therefore you need less. Secondly, the liver enzymes in the gut break the hormones into metabolites (i.e. breakdown products) some of which aren’t best for the body (the breasts in particular).
Levels of testosterone should be looked at also due to how they affect energy levels. It is possible to restore levels with a testosterone cream which can have a huge beneficial impact especially for those in their late 30s, 40s, and 50s.
Monitor vitamin D levels. Many women are deficient in this at the moment and as a result are more tired. Low iron reserves can also lead to increased tiredness - checking ferritin is important in this regard as it acts as a measure of iron stores.
During pregnancy, it’s perfectly normal to feel tired, particularly at the beginning and end. Having lots of rest, plenty of hydration and good nutrition are key here. Following pregnancy, things only get more tiring and mood is often compounded by low energy levels. Hormones restoration is the best way to improving energy levels in this case.
Jane Wake , Master of Science, Sport and Recreation Management.
Dr Stefanie Williams , Dermatologist and Medical Director at European Dermatology London. For more information on hormones and skin, check out her book ‘Future Proof Your Skin! Slow down the biological clock by changing the way you eat,’ £9.99.
Dr Jan Toledo, doctor and sexual health specialist, Marion Gluck Clinic .