Are your Hormones Driving You Crazy?

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Ronna Sherman, MD, has expertise in weight management, women's health, and internal medicine. She is located in the 233 Millburn Avenue office of the Summit Medical Group, in Millburn, New Jersey. In this presentation, first given on our Berkeley Heights campus, Doctor Sherman discusses menopause

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Are your Hormones Driving You Crazy?

  1. 1. Are Your Hormones Driving You Crazy? Ronna Sherman MD October 26,2011
  2. 2. How the King of Beasts Handles PMS
  3. 3. HORMONES Hormones are natural chemicals produced by the organs and tissues of the body Released into bloodstream and used by targeted organs and control their function Hormones are then broken down (metabolized) by body after they are used
  4. 4. Hypothalamus: Dopamine, TRH, GHRH,CRH, GnRHPituitary: Prolactin, Growth Hormone, Thyroid Stimulating Hormone, Adrenocorticotropic Hormone, FSH, LH,Thyroid Thyroid HormonesParathyroid Parathyroid HormonePancreas: Insulin & GlucagonAdrenal gland: Aldosterone, Cortisol, DHEA, EpinephrineKidney: Vitamin D, Renin, ErythropoietinOvaries Androgens : AndrosteinedioneTestes & Testosterone
  5. 5. AGINGFSHLHNorepinephrineParathyroid Cortisol Epinephrine Insulin Thyroid Aldosterone Calcitonin Growth hormone Renin
  6. 6. Effects of AgingThyroid Lumpy(nodular), metabolism declinesParathyroid OsteoporosisInsulinAdrenal gland: Increased blood glucose levels Aldosterone Orthostatic hypotension Cortisol Cortisol blood levels stay same DHEA DHEA levels decrease EpinephrineOvaries & Testes Testosterone and estrogen/estradiol levels decline
  7. 7. Peri/Menopause Weight Depression
  8. 8. Emotions and Hormones
  9. 9. Peri/Menopause
  10. 10. Factors that Affect the Onset of Menopause Earlier onset  Current smoking  Nulliparity  Pelvic radiation and chemotherapy  Medical treatment for depression  Familial Later onset  Multiparity  Increased body mass index  Higher cognitive scores in childhood  Familial
  11. 11. Puberty in Reverse
  12. 12. Transition to Menopause
  13. 13. Hot Flashes Behavioral Interventions Antidepressants : SSRI and SNRI Gabapentin Complementary and Alternative Therapy Short term Hormone Therapy
  14. 14. Sleep and Menopause Frequent awakenings Difficulty falling back to sleep Difficulty falling asleep More common in women with surgical menopause Those with sleep difficulty are more likely to have depressive symptoms
  15. 15. Recommendations Low dose OCP Medications Hormonal Therapy OTC Vaginal Estrogen
  16. 16. Color-Enhanced Scanning Electron Micrograph of Adipose Tissue, Showing Adipocytes. Apovian CM. N Engl J Med 2006;354:1101-1102.
  17. 17. Hormones produced by Adipose Leptin Stimulates energy expenditure Inhibits food intake Restores euglycemia Adiponectin Increased insulin sensitivity Energy expenditure Reduced production of glucose by liver Obesity is associated with Leptin Resistance
  18. 18. Obesity and InflammationAdipose (fat) is site of energy storageAs fat cells grow :  Invaded by Macrophages  TNF α and IL-6  Blocks insulin  Cause inflammation  Decrease in production of Adiponectin
  19. 19. Biologic Mechanisms Protecting Adipose Tissue Mass
  20. 20. Why It’s So Difficult to Loseand Maintain Your Weight Loss of sex hormones Disruption of normal insulin function Adipose tissue is self preserving
  21. 21. Depression Ongoing feelings of sadness, guilt or hopelessness Loss of interest in things you once enjoyed Significant changes in sleep pattern Fatigue or unexplained pain without cause Changes in appetite Feeling as though life isn’t worth living
  22. 22. Depression and Menopause 1.3 million women reach menopause annually 20% experience depression at some point Risk is greater in perimenopause Estradiol  decreases the level of enzyme that degrades 5HT and Norepinephrine  increases the level of enzyme that produces serotonin and norepinephrine
  23. 23. BIOLOGY of DEPRESSION serotonin Dopamine norepinephrine
  24. 24. Treatment Seek assistance Medication Psychotherapy Hormonal therapy
  25. 25. Additional References• The Endocrine Society www.endo-society.org• The Hormone Foundation www.hormone.org• Highlights from the 66th Annual Meeting of the American Society for Reproductive Medicine October 2010• Mayo Clinic Proceedings June 2004• Wwww.Women’s Health.gov• Cleveland Clinic Center for Continuing Education• Women’s Health Initiative: http://www.whiscience.org/• The Heart and Estrogen/Progestin Replacement Study (HERS) http://www.nhlbi.nih.gov

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