Women's Wellness Wednesdays

I think it's safe to say that Wednesdays are often the day of the week that find most people just trying to make it through. It seems to have the most nicknames of any day of the week - be it "Hump Day", "Midweek", "It's Thursday Somewhere Day", "Worstday", etc. Well over here I am giving Wednesdays my own term and hoping to brighten up the bleakness of that midweek grind by bringing Women's Wellness Wednesdays to you. Stop by on any given Wednesday to find some great wellness tips specially designed for all you ladies and all of you who love ladies.

Estrogen, the Brain, and Happiness

Estrogen. The hormone to end all hormones in the female system. It has the potential to hijack our hearts, our minds and our sanity. And speaking of sanity - today we will be discussing the crucial role that estrogen plays in our brains. I want you to meet a patient of mine, Trudy (*name changed to preserve her identity). Trudy came to see me at age 51 complaining of feeling "not right" in the head. Her symptoms ranged from brain fog, issues concentrating, difficulty with word recall, to the most troubling symptom of all - apathy and what she termed in question form to me, "maybe it is a little bit of depression?". To put it bluntly, Trudy just didn't care anymore. She had lost her joie de vivre, her spark, her hope and the fact that this didn't even bother her troubled her even more. (Let me just pause here and say that Trudy could in fact be almost every late 40s to early 50s female patient that walks into my office - these symptoms tend to be rampant in this population). Long appointment short - Trudy is in the hotbed of perimenopause (the time leading up to actual menopause when periods stop and our ovaries take a permanent vacation). What this means is that she is on a downhill ski slalom experiencing a significant change in hormones, leading to much lower levels of hormones such as estrogen in her system.

So let's get down to the real juicy stuff about estrogen and its effects on the brain. In our brain we have a plethora of estrogen receptors that mediate dozens of different brain processes. Estrogen in the brain does everything from increasing blood flow, decreasing inflammation, protecting neurons from oxidative stress, improving nerve growth, preventing neuronal cell death to increasing serotonin release at nerve synapses (1). These wide ranging effects of estrogen in the brain mean that any time any women experiences a drop in estrogen (which can basically be once a month right before the period for most women) she will most likely also experience alterations in brain function. For Trudy, who as a perimenopausal women is experiencing more chronic long-term drops in her estrogen levels, this has led to noticeable and significant changes in her brain function. In regards to the relation between estrogen and depression, estrogen compounds are closely tied to a special neurotransmitter called serotonin. Serotonin is our feel-good, joy-inducing neurotransmitter. Many of the most common antidepressant pharmaceuticals are in the category of SSRIs (selective serotonin reuptake inhibitors). The idea is that we can change symptoms of depression by increasing the amount of serotonin hanging out in the synaptic cleft (i.e. the brain). Estrogen can both increase the release of serotonin but also block the uptake of the serotonin - which in both cases leads to greater levels of serotonin. When estrogen levels drop to a lower overall state it means less estrogen in the brain and less serotonin. This is the cause of my patient Trudy's apathy. I'm sure Trudy would have also been interested to hear that a recent study demonstrated that long-term treatment with estradiol (a specific form of estrogen) is as effective as treatment with sertraline (an SSRI drug) on symptoms of depression when used in states of low estrogen.

So to all of you women out there wondering if you are hanging out on the edge of "crazy" - you aren't. There is a real, physiological reason to why you are having these feelings. And it's name is estrogen. There is hope for Trudy, who within a few months of targeted herbal and bio-identical hormone therapy felt like she had her "old brain back", and there is hope for all of you. Coming next week Wednesday - my favorite herbs for helping women find balance in menopause.

  1. Sheppard JE. Effects of estrogen on cognition, mood, and degenerative brain diseases. J Am Pharm Assoc. 2001;41(2).