Maggie McKay (Host): Welcome to the Better Health Podcast from Tidelands Health. I'm your host, Maggie McKay. Today, we'll learn about how to balance your hormones with obstetrician and gynecologist, Dr. Monica Selander. Thank you so much for being here.

Monica Selander, DO: Thanks for having me. I'm excited.

Host: Let's just start with: What roles do estrogen and progesterone play in the menstrual cycle?

Monica Selander, DO: Sure. Those are two of the main players. There's two portions of the menstrual cycle. So, we've got what's going on in the ovary and we've got what's going on in the uterus. So, these hormones play different roles in those two locations, and they play different roles based on which point of the menstrual cycle we're in, whether we're in the first half, which is before ovulation, or in the second half after ovulation.

So in the earlier part, when we're talking about the uterus, estrogen's role is to start to make the lining of the uterus become a nice, happy place for an embryo to implant. So, it causes some growth and proliferation of the lining of the uterus. The progesterone is not doing a whole lot at that portion in the earlier part of the menstrual cycle. When we move into the second half, estrogen is still high, but kind of drops off and then progesterone really kicks in and begins to do its role, which is to maintain that lining. And it's role towards the very end of the cycle depends on whether or not a pregnancy forms. So if a pregnancy forms that progesterone continues to maintain that pregnancy, keeps the uterus quiet to keep everything in and where it should be. Whereas if a pregnancy does not form, the progesterone dropping off is what triggers you to have a period. So, that's what's going on in the uterus.

When we talk about the ovary, the beginning part of the cycle is when we're building up follicles, which will eventually lead to ovulation. And in the second half, that follicle is what then becomes the source of progesterone, which as we talked about, is doing really important work for the uterine lining, either maintaining a pregnancy or triggering a period.

Host: And what symptoms might indicate that something is going on?

Monica Selander, DO: That something's abnormal? The biggest sign would be irregularity in the menstrual cycle. Because the portions that we talked about, the beginning of the cycle and the second half of the cycle, the second half is usually pretty constant. So after ovulation, a period will generally start about 14 days later. The beginning part of the cycle is what can have some variance to it, both in one person from one menstrual cycle to another, and then differences between different people. So when we see someone who says, "I have pretty regular periods. They're about every 28 to 32 days. They come pretty regularly," that shows that things are usually working.

If we have someone who says, "Well, I go months without having a period," or "I had a period six months ago and nothing since," or "I'm bleeding for weeks, and then I have a brief break, and then I bleed again," signs that we're not having that nice cyclical menstrual cycle means that something's not functioning properly.

Host: How do testosterone levels affect women?

Monica Selander, DO: So, testosterone kind of hangs out in the background and doesn't really cause much of-- it doesn't do a whole lot until it's in excess really, is when we start to talk more about testosterone. Testosterone is what's called an androgen, so that's more what we think of like a male hormone. Although all women have it and it is there functioning for us, we tend to see problems when testosterone is too high or too active, when we see signs of extra hair growth or extra acne, some things that we will see, like in our ladies with PCOS, that indicates that there might be a little bit extra testosterone activity.

Host: Dr. Selander, what are the potential signs that these levels might be abnormal?

Monica Selander, DO: The main thing I would say when we talk about levels as well is it's more of a function. So if we're seeing that things aren't functioning, like we mentioned with the irregular periods, that's a sign that things are off. I mentioned that versus levels because these hormones we talked about, although testosterone has more of a cutoff of what's high and what's not, when it comes to estrogen and progesterone, which we know are very important to keep this cycle functioning, there's not really as firm of a level that says this is too high, this is too low for a few reasons. One being that there are different levels throughout the cycle. They can be vastly different. The other reason being that people's physiologic response to a certain level is different. So, one person who has an estrogen level of X at the same part in their menstrual cycle may respond perfectly well to that level, whereas someone else, even though it seems to be the same, their tissue just doesn't have the same responsiveness and they don't respond. So instead of a level abnormality, it's really more of a function, like is it functioning or does it seem dysfunctional?

Host: And what role do hormones play in women's reproductive health beyond fertility?

Monica Selander, DO: There can be a lot. It's definitely complex as it plays into a lot of different things. So, the main thing that keeps coming to mind as we're going through this discussion is the condition of polycystic ovarian syndrome, because this is very common and this is where we see some of the other problems that come into someone whose hormones are not functioning properly.

So, to kind of go off of that, someone with PCOS, in addition to these menstrual irregularities, we have something called the metabolic syndrome. So, these are other things that these reproductive hormones are also a part of, but we see other issues with. So, things like obesity, high blood pressure, insulin resistance, so like forms of diabetes or pre-diabetes, abnormal lipid panels, abnormal cholesterol. This whole metabolic panel runs along with that situation where we're having dysfunctional hormones.

Host: And when is a specialist consultation advised?

Monica Selander, DO: We will usually tell people if you're having irregular menstrual cycles for more than three months, we should check it out. The body and the menstrual cycle, in general, it can be a little bit sensitive, so sometimes things like a change in medication or life stressors or weight changes can briefly and transiently cause some irregular menses that may just go back to being completely normal if you give them a little bit of time. Once we see that three months of irregularity have occurred is when we usually want to go ahead and check that out.

Host: So, the big question, what can we do to help keep things working as they should? Is it through diet, exercise, medication?

Monica Selander, DO: Diet and exercise are never the wrong answer because this is essentially no risk and no downside. The commitment is just the time commitment and the effort. And it's definitely easier said than done when we start to get into things like weight loss and having good diets, which is difficult both from it's harder to find good food, good food's more expensive, there's more time into preparing fresh foods versus packaged and processed foods. So even though it's always the first step and it is the safest, low risk way, it can be challenging.

But beyond things like diet and exercise and keeping our input to our bodies healthy, it really depends on what an individual's desires are in forms of like their reproduction. So, someone who has come in and we've identified a problem, they're having irregularity, we've found a diagnosis, if they're someone who doesn't want a pregnancy currently, it's a lot easier. That gives us a lot of treatment options because we're able to treat with different types of medications that are usually different forms of birth controls. Even though we have contraceptive pills, shots, patches, implants that are used for contraception, we also use them for treatment of irregular bleeding and to help provide other protection based on what's going on with their situation.

Now, if they're someone who desires a pregnancy, that's a little bit more difficult because if we use any of those treatments that we use to help regulate their menses or decrease the symptoms of troublesome bleeding, it'll prevent a pregnancy. So, it really starts with what are their desires in that realm that'll guide our treatment.

Host: In closing, is there anything else you'd like to add that you'd like people to know?

Monica Selander, DO: If you think you're having symptoms of a menstrual cycle irregularity, the first thing I would suggest is to get a period tracker app on your phone. Because what I'll hear a lot of times is people will say, "Well, I usually get my period at the beginning of the month, but this month, it was at the end of the month. And they'll talk about like a calendar whereas to get really good data about your cycle of regularity, it's really a number of days that the cycle lasts. So when you input that into a period tracker app, as you add more and more data to it, it's going to tell you your average cycle length is this long, and you'll also be able to see, "Well, this cycle was 34 days, this cycle was 32 days." It gives you more like useful data and sometimes you look at it and you'll be like, "Oh, it's more regular than I thought. You know, actually, it doesn't look too bad," or if you're like, "Oh wow, there's a really big variance here, and when you bring it in, once you come to be evaluated, that gives us some really nice information where I can look and say, "Yeah. You're having 60 days between a cycle" or you know, it just gives us really nice information and it's very helpful.

The other thing I'd mention is just that timeframe. You know, if you do go three months where you're having irregularity, please don't hesitate to reach out to be evaluated and be seen. And the other thing I'd mentioned timeline-wise is if you have a history of irregular cycles when it comes to fertility and conceiving a baby. Normally, we say that it is normal to take up to a year to conceive, and that is true. But when it comes to someone who has a history, either a known diagnosis of PCOS or a long history of very irregular cycles, we like to check that out a little bit sooner after about six months of actively trying.

Host: Thank you so much for sharing your expertise. This has been so informative, and I'm sure you're going to help a lot of people who see this.

Monica Selander, DO: Thank you. It was great to be here.

Host: Again, that's Dr. Monica Selander. Schedule an appointment by calling 1-866-TIDELANDS. And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. Thank you for listening to the Better Health Podcast from Tidelands Health.