1. Are Your Hormones Driving You
Crazy?
Ronna Sherman MD
October 26,2011

2. How the King of Beasts Handles PMS

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. Hypothalamus: Dopamine, TRH, GHRH,CRH, GnRH
Pituitary: Prolactin, Growth Hormone, Thyroid Stimulating
Hormone, Adrenocorticotropic Hormone, FSH, LH,
Thyroid Thyroid Hormones
Parathyroid Parathyroid Hormone
Pancreas: Insulin & Glucagon
Adrenal gland: Aldosterone, Cortisol, DHEA, Epinephrine
Kidney: Vitamin D, Renin, Erythropoietin
Ovaries Androgens : Androsteinedione
Testes & Testosterone

5. AGING
FSH
LH
Norepinephrine
Parathyroid
Cortisol
Epinephrine
Insulin
Thyroid
Aldosterone
Calcitonin
Growth hormone
Renin

6. Effects of Aging
Thyroid Lumpy(nodular), metabolism declines
Parathyroid Osteoporosis
Insulin
Adrenal gland: Increased blood glucose levels
Aldosterone Orthostatic hypotension
Cortisol Cortisol blood levels stay same
DHEA
DHEA levels decrease
Epinephrine
Ovaries & Testes Testosterone and estrogen/estradiol
levels decline

7. Peri/Menopause
Weight
Depression

8. Emotions and Hormones

9. Peri/Menopause

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. Puberty in Reverse

12. Transition to Menopause

14. Hot Flashes
 Behavioral Interventions
 Antidepressants : SSRI and SNRI
 Gabapentin
 Complementary and Alternative Therapy
 Short term Hormone Therapy

16. 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

18. Recommendations
 Low dose OCP
 Medications
 Hormonal Therapy
 OTC
 Vaginal Estrogen

19. Color-Enhanced Scanning Electron Micrograph of Adipose Tissue,
Showing Adipocytes.
Apovian CM. N Engl J Med 2006;354:1101-1102.

20. 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

21. Obesity and Inflammation
Adipose (fat) is site of energy storage
As fat cells grow :
 Invaded by Macrophages
 TNF α and IL-6
 Blocks insulin
 Cause inflammation
 Decrease in production of Adiponectin

23. Biologic Mechanisms Protecting Adipose Tissue Mass

24. Why It’s So Difficult to Lose
and Maintain Your Weight
 Loss of sex hormones
 Disruption of normal insulin function
 Adipose tissue is self preserving

25. 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

26. 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

27. BIOLOGY of DEPRESSION
serotonin
Dopamine
norepinephrine

28. Treatment
 Seek assistance
 Medication
 Psychotherapy
 Hormonal therapy

29. 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