Julie finds herself crying without explanation. She has screaming fits over minor things. The next day, she is not sure why she was so upset. She knows her behavior is creating a lot of stress in her relationship with Phil, but doesn’t know how to change it.
Julie doesn’t feel like herself for a few days each month. She senses her behavior changes with her menstrual cycle. She discussed it with her physician who told her it was expected and normal.
Paul just passed his 45th birthday. He feels lethargic and lost motivation for the usual activities that were once stimulating to him. His body doesn’t feel the same to him. He finds himself withdrawing from his family. He is questioning everything about his life. He feels like giving up.
Julie discusses her problem with her wellness coach. “I feel like I am out of control some days. I am irritable, anxious and feeling on edge. I get my period and then I feel normal again. I don’t know what to do. When I am in the midst of these changes, I have no idea how to control my emotions or my behavior. The other day, I totally lost it because one more time, the dirty dishes were left on the table. I know my boyfriend is getting fed up with me. He knows it has something to do with my cycle so whenever I am upset about something, he asks: ‘Is it that time again?’ I really feel he is not taking me seriously. That makes the problem worse.”
Paul feels the opposite of Julie. He feels he has no edge at all. He describes the changes he has gone through recently. “I can’t pull it together. I don’t know what I want anymore. I am tired most of the time and nothing seems to be very important. I think I am depressed, but I have never been this way before. Nothing has really changed in my life. I can’t really account for why I don’t feel like myself. I use to be a real go-getter, now I don’t really care very much about anything.”
Recent research has supported the belief that emotional homeostasis, or the lack of it, is highly influenced by estrogen. Estrogen may play a substantial role in learning, memory and mood. Science has demonstrated a link between estrogen and serotonin levels in the brain. Serotonin is linked to mood regulation.
On the flip side, there is some research to indicate that men experience effects from hormonal changes as well. As men age, their testosterone levels decrease and they are more prone to the following changes: depression, lack of energy, decreased strength and endurance, decreased enjoyment, deterioration in cognitive/physical agility and sharpness, decreased sex drive and erectile dysfunction.
The changes that men go through during the down cycling of their testosterone, is called andropause. Testosterone decreases steadily after it reaches its peak in late teens and early twenties. The decrease becomes significant enough after age 40 to be noticed with overt signs and symptoms that Paul described.
Paul and Julie feel like transformed people because of their hormones. Testosterone and Estrogen play significant parts in our lives in addition to the obvious effect on sex drive and behavior. The hormones also work in parts of the brain called the limbic system. The limbic system consists of very important structures, such as the hypothalamus, amydala and hippocampus. These structures play important roles in energy regulation, sleep, biorhythms, mood, motivation, memory and stress management.
Estrogen levels can vary for women not only during the normal course of a cycle, but as a result of aging and from medical conditions. An example of a medical condition is polycystic ovarian syndrome (PCOS). Estrogen levels are lower than normal with PCOS signaling a change in mood. Higher levels of estrogen may be responsible for higher levels of serotonin. Serotonin is a neurotransmitter that helps to regulate mood. A decrease in serotonin can lead to depression. During pregnancy, estrogen levels are very high. After delivery the estrogen levels plummet. The swift and dramatic change in estrogen levels account for decreased serotonin levels: the leading cause for depression. After women give birth, they are more susceptible to depression because of the dramatic decrease in estrogen. Post-partum depression is a very real, biological disorder.
When men experience a downturn in testosterone, they are more likely to be even tempered and relaxed. Too little testosterone can lead to depression and irritability. In women, the fluctuations in estrogen are more clearly linked to mood changes.
Men and women share the same hormones. Women have testosterone and men have estrogen. Of course the higher levels are responsible for the gender differences in each sex. The more recent research findings are providing interesting developments in the comparison of men and women.
Men have larger brains (correlated with larger body size) but women have more gray matter. Women have larger corpus collasums (a structure that connects the two sides of the brain). Men score higher on tests of spatial relationships. Women score higher on tests of verbal reasoning. It is more likely that women use both sides of the brain when language is involved, whereas men use the left brain only.
Significant gender specific changes occur in the brain prenatally and shortly after birth. During the early stages of development and before birth, the brain is at its most sensitive and responsive state when exposed to gender specific hormones. When females are prenatally exposed to androgen (due to a congenital disorder), they behave more like boys. When gender specific hormones are administered to the opposite sex during adulthood, there are physical changes, but, it is believed that the struturalization and organization of the brain that occurs in the early stages of development, are no longer susceptible to the same types of changes in adulthood. In other words, the male and female brains become fixed at very early stages of development.
Research indicates that estrogen and testosterone have physical and cognitive benefits. Estrogen has been linked to improved cognition in older age with improved ability to recall and learn new things. It is associated with neuro-protective elements and it is believed that we are less likely to experience neuro-degenerative diseases when estrogen is sufficient.
They talk to her wellness coach seeking help with managing the problems. Phil describes his experience: “I can’t take all the yelling and irritability. It seems the smallest things get on her nerves and I feel like I don’t have room to breathe in this relationship. I am even afraid to talk openly. When I come home at night, I am ready to relax. I just want to tune things out and chill out. I’m afraid she is going to get upset and we are going to have another bad weekend. When she is calm everything is great. We have good time together and we enjoy each other’s company. I wish she didn’t have a period. If she didn’t everything would be fine.”
Julie has a different point of view. “I think there are some real problems in our relationship. He thinks that everything is due to my period and it’s not. He doesn’t show enough understanding and sensitivity. I feel I have to yell to get his attention. He blows me off a lot. I am not sure why he is acting the way he does. Why doesn’t he care more? I think he should be upset too that the problems bother me as much as they do. Maybe my period causes me to react more strongly, but that still doesn’t dismiss the fact that there was something there that either hurt my feelings or disrespected me.”
Julie and Phil were provided with some suggestions on how to deal first with changes in mood. They were provided with some education about how the changes in hormone affect them. When Phil is having low levels testosterone, he is ready to relax. He is at low tide, so to speak and wants to relax. When Julie has been building up her irritability and frustration during the day, she comes home and experiences another frustrating situation, she is primed to release those emotions. Julie was provided with a planner in which she could keep track of her cycle and record her differences in her mood states. She is less likely to feel out of control which only exacerbates her experience and makes her feel even more irritable.
Paul describes the changes in himself and family life. “I just don’t feel like myself. I don’t have the same drive. I am not as interested in my wife sexually. I feel like I have lost the zest for life. I look back on my life and I think ‘what was the point of it all?’ I don’t like my body and the changes it has gone through. I use to be fit and it was so easy to lose weight. I have a pot belly now and I can’t seem to get rid of it.”
Paul is experiencing a change in testosterone levels that has caused him to have physical changes. For females, the stage of menopause does come with physical symptoms similar to what Paul is experiencing, and at times, some women experience mood changes as well. The fluctuations in estrogens and then the steady decline in estrogen during menopause are experienced differently among many women with more or less severity or with minimal changes. For men, the changes are very real and can vary in severity.
Paul was provided with education on how to identify these changes and he realized that the lowering of hormone levels was the cause of these changes. Paul experienced symptoms that could be assessed as depression, but in reality the physical changes were most damaging to his self worth and self esteem. He sought the attention of a physician for hormone replacement therapy (HRT).
The scientific jury is still out where HRT is concerned. There is proliferation of evidence that replacing estrogen is helpful in many ways, but there is also some evidence that there may be increased health risks. To determine if HRT is right for you, you and your physician need to assess your particular needs and health history and genetic risks. If mood changes are severe enough to interfere with your ability to enjoy life and function normally, you should have an assessment by a health care professional to determine if you do meet the criteria for depression. There are treatments that are proven helpful for depression which includes antidepressants and various therapies, such as cognitive behavior therapy, that are proven helpful in the remediation of depression.
Paul decided to take HRT. “I feel so much better. My vigor has returned. I am interested in sex again. I feel more like myself.”
Julie learned to manage her moods and behavior differently. “I keep a journal and when my cycle is about to occur I know take a deep breadth over everything before I react. I talked to my gynecologist too and she thinks that I could try birth control pills to regulate my hormone levels. I am still thinking about option. I prefer more natural ways to manage my health. Phil and I are getting along better. He knows not to write everything off to hormones and he is listening better as I am talking in a more calm way. I learned a lot about my body and how it reacts to hormone. It’s making it easy for me now that I feel I have an owner’s manual that provides some trouble shooting directions.”
Dr. Vanessa Gourdine is a psychologist, executive and life coach and Director of Specialized Therapy Associates, LLC and Life Work Strategies, LLC. She can be reached atDrG@LWSCoach.com. She has a behavioral health column in BC Magazine and is a regular contributor to lifestyle publications. She has developed a coaching model based on using strategies to influence growth and change for successful living. She can be reached at 201-224-5200.