Women and Hormones

Hormones influence a woman’s health and sense of wellbeing throughout her life. Whether on the cusp of puberty or the last stages of menopause, hormones play a starring role in how a woman looks, feels, and functions.

As you go through each stage, a midwife can counsel, evaluate, advise, and care for you. The midwifery philosophy of care goes beyond pelvic and breast exams, advice about contraception, and guidance through pregnancy. Midwifery care is synonymous with an emphasis on wellness.

Hormones during adolescence. While menstruation generally starts at 12 or 13, there is considerable evidence that girls are beginning puberty earlier. By the age of eight, 48% of African American girls and 15% of Caucasian girls are beginning to show secondary sexual characteristics, including pubic hair and breast growth. In a world that is overflowing with sexually explicit images, most mothers understand that they need to provide accurate information and value-based guidance. Even more heart-stopping is the realization that your daughter will soon need her first pelvic exam. With plenty of horror stories to go around, the importance of an age-sensitive, gentle, empowering exam cannot be overemphasized. Mothers are learning to seek the service of midwives, nurse-practitioners, or physicians who have a knack for caring for adolescents.

Hormones play an important role in the early years of a young girl’s menstrual cycles. Painful periods, irregular bleeding, and occasional heavy bleeding are common in the first few years following menarche — the first menstrual period. Young girls may not ovulate (produce an egg cell) during each of their early periods. Consequently, a deficiency of progesterone can result, followed by a delayed, heavy menstrual period.

Generally, health care practitioners suggest that young girls suffering from painful cramps and heavy bleeding should rest, get adequate fluid intake, use a heating pad on the lower abdomen or back, and take over-the-counter medications such as ibuprofen (Advil) or naproxen sodium (Aleve).The added advantage of naproxen sodium is it reduces the body’s production of prostaglandins, which are responsible for making the uterus contract.

For an older adolescent who is suffering from heavy bleeding or cramping, a midwife might prescribe the “pill” or Depo-Provera or Lunelle shots, even if the teen doesn’t need birth control. These methods reduce painful menstrual side effects because they prevent ovulation and all the subsequent hormone changes that can lead to pain or heavy bleeding.

A midwife can help a teen choose an appropriate pill, perhaps one that will also decrease acne. A midwife will review possible side effects and caution against smoking, which is particularly dangerous while using the pill. Some teens who have trouble remembering to take a pill every day opt for birth control shots, which are taken every one to three months. With this method, the midwife will emphasize the importance of eating foods that are high in calcium or recommend calcium supplements.

The cyclic changes of hormones are one of the underlying causes of premenstrual syndrome (PMS).The most common symptoms include breast tenderness, mood swings, food cravings, irritability, depression, fatigue, and water retention. About 75% of women experience one or more of these symptoms every month — and they can be very disrupting. Over-the-counter medications such as ibuprofen and naproxen sodium help relieve some symptoms. Depending on the severity of the symptoms, a midwife may prescribe contraceptive injections, oral contraceptives, or a low dose of antidepressants to be taken the week before the expected period.

Hormones during the reproductive years. Hormones play a very big role in a woman’s ability to conceive and sustain a pregnancy. An imbalance in a woman’s estrogen and progesterone levels can cause a variety of problems. It might prevent the fertilized egg from implanting in the womb or cause the uterine lining to slough off rather than continue to nourish the developing fetus. Although there are few serious complications from a miscarriage, it is important to receive care from a midwife or a doctor, and one should not minimize the emotional impact. Some women suffer from repeated miscarriages and need intensive evaluation and treatment.

During pregnancy, hormones often cause breast tenderness, exhaustion, pubic-bone pain, and many other ailments. A midwife will advise you of comfort measures you can take to ease the aches and pains of pregnancy without endangering you or the baby.

Midwives are a source of comfort and counsel during the postpartum period as well, when a woman’s hormones are still in flux, often resulting in postpartum blues and occasionally leading to major depression. Breastfeeding also affects a woman’s hormones by delaying the onset of menses and/or, causing vaginal dryness, which can make sexual intercourse uncomfortable. Routine instruction on the how-to of breastfeeding should include information on options for birth control and increasing vaginal lubrication.

Many women have been surprised to discover that midwives care for women throughout their reproductive years, even if they’re not actively trying to conceive. The midwife will explore possible choices of contraception (with her partner, if requested), correct common misconceptions, and help the woman choose a method that will be safe and successful for her. For example, the birth-control pill is considered unsafe for a woman over 35, a heavy smoker, any woman with a history of blood clots, or a woman who has active liver disease. Once the midwife has determined what is safe for the individual, she makes sure that the client understands about appropriate alternatives, how each method works, and what best fits the patient’s lifestyle.

Hormones and menopause. As women reach their fifties, the production of hormones becomes irregular and so do the menstrual cycles. Menopause, the final menstrual period, marks the end of a woman’s naturally-occurring reproductive years. Interestingly, menopause is almost always diagnosed in hindsight. If you are over the age of 50 and have gone six months without a period, you are probably menopausal. After 40 to 50 years of living with the reproductive hormones, the body can show symptoms of withdrawal. Most women will experience hot flashes (or flushes) and vaginal dryness. Some women hardly notice these symptoms, and others find them intolerable. All women who have arrived at this important landmark in their lives should receive personalized evaluation and counseling from a health care professional.

Few women know the options for easing the transition to menopause, improving the quality of life after menopause, and living longer. Midwives provide health care and counseling through the peri-menopausal years and beyond, including:

• Preventive measures for conditions that are increasingly common as a woman ages, particularly those (like heart disease and osteoporosis) that have an increased risk with the reduced estrogen levels found in a woman’s body after menopause.
• The advantages and disadvantages of hormone replacement therapy and self-help measures.
• The importance of a healthy diet (low in fat, high in calcium) and exercise — aerobic for the cardiovascular system and weight-bearing for the bones.
• The role of herbal therapies.
• Signs and symptoms that might signal a serious health problem (such as bleeding between periods).

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*taken from “Midwife for Life” by Ronnie Lichtman, Every Baby magazine, Issue Two.