A subset of women experience instability in their neurological or emotional well being because of hormone changes.
For example, some studies investigating this have looked at women with and without premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD). They found that the PMS / PMDD women have a higher occurrence of mild changes on EEG-brain wave tests, subtle right/left differences on neurological examination, family members with depression, a past history of concussion, migraine headaches or even left-handedness, compared to women without PMS or PMDD. These anomalous brain conditions are thought to bring anomalous brain responses to hormones.
A dramatic example of this is a 43-year old woman who had never had PMS until after she had hit her head on the windshield of her Saab in a serious fender bender. Six months later she came in for a neuroendocrine consultation because she could not be around her twin teenage daughters during her premenstrual week because of yelling and screaming and a loss of control with them. This behavior was completely different than from before her concussion.
More generally, there are key times in women’s lives when these brain/hormone changes can become troublesome. The first is around the time of a young woman’s first period, menarche, during puberty. During this time there are surges of estrogen happening months before progesterone begins surging. This brings the “unopposed” estrogen state I have referred to in recent blog posts.
Another key time is if and when a woman first takes a birth control pill. Birth control pills contain estrogens that act in the brain, but none contain natural progesterone. Instead they contain synthetic progestins, which do not have brain activity. Progesterone has powerful brain activity that can offset the estrogen. From the brain’s point of view, taking an estrogen-containing birth control pill is like taking “unopposed” estrogen.
I have discussed in other blog posts the times in a woman’s regular monthly menstrual cycle when surges in estrogen, and/or the withdrawal of progesterone, can cause trouble. Moreover, after giving birth, during the post-partum time, the large withdrawal of estrogen and progesterone can cause a woman trouble because of low estrogen (depression, migraine headaches) or even lower progesterone compared to estrogen (seizures, anxiety).
Finally, in the years leading up to menopause, during the peri-menopause, predictable hormone changes take place in women, including declining and varying levels of estrogen, which can bring “brain fog”, migraines and mood changes, and the absence of progesterone once periods start skipping, which can bring seizures, anxiety and irritability.
Surveying how a woman has experienced these key times in her life is the cornerstone of taking a neuroendocrine history and assessing if she is sensitive to these brain/hormone changes. This the first step in providing her clinical help.