In their mid to late-30’s, women will often experience a decline of progesterone. Progesterone is responsible for maintaining the lining of the uterus should an egg implant. This decline happens for several reasons. Put simply, there is less motivation for the body to reproduce, so there is a decline in the production of progesterone. Without optimal levels of progesterone, estrogen levels dominate. Fluid retention, headaches, impatience, anger, irritability, bloating, and breast tenderness can denote estrogen dominance. Administering bio-identical progesterone during this time can be helpful.

Oftentimes, when the decline of progesterone is already present, women in their 40’s begin to experience the first slow decline of estrogen. This decline can lead to feeling warmer with mild hot flashes, night sweats, difficulty sleeping, cognitive challenges, and most commonly, an increase in teariness, depression, and feeling very sensitive with regard to feelings and self-esteem.

In my experience, there are two primary types of depression to differentiate from at mid-life. One is chemical depression, which is often hereditary and caused by imbalances of the neurotransmitters dopamine and serotonin. This type of depression is more likely to respond to prescription medications or amino acids. The other more common type of depression can be secondary to a decline of estrogen.

The initial decline in estrogen is slight enough that there is no change in monthly bleeding. However, women can feel changes happening. The most common first sign of less estrogen being present is teariness and depression. Women may suddenly find themselves with a lowered self-esteem, feeling overly sensitive to remarks by others, or becoming teary or crying for no apparent reason. This depression prompts visits to health care providers, who in turn often write a prescription for an anti-depressant. These prescription medicines may be helpful, but they are not addressing the root cause of the depression. The cause for many women’s new onset of depression in the 40’s can often be alleviated with a very low level of bio-identical estrogen.

Bio-identical hormones refer to the chemical structure of the hormone molecule. They contain the exact molecular structure as hormones made in the body. The source of the hormones is often yam or soy, which is converted by chemists into bio-identical hormones. These hormones are found to be indistinguishable from those produced by the human body and exert the same physiological response.

Estrogen is not a single hormone; rather, it is a group of different hormones that perform functions normally attributed to estrogen. The three estrogens that predominate in an adult woman are Estrone, which constitutes 10-20% of circulation estrogen; Estradiol, also at 10-20% of circulating estrogen; and Estriol, which is about 60-80%. Estrone is a weak estrogen produced by the oxidation of Estradiol and is the primary estrogen present after menopause. Estradiol is the most potent estrogen secreted by the ovaries and has the strongest estrogenic effects throughout the reproductive years. Estriol is a weak estrogen that has anti-estrogenic properties.

Any combination of bio-identical estrogens can be compounded for women to support them through hormone imbalances. Common combinations include Triest (80% Estriol, 10% Estrone, 10% Estradiol) and Biest (80% Estriol and 20% Estradiol). Estriol can be administered as simply Estriol. This has been used in Europe as an estrogen replacement for over 20 years. These compounded estrogens are safe, tolerated extremely well, and easy to regulate.

Estriol is the weakest estrogen and can be replaced at very low doses. It is so low, in fact, that it won’t affect the menstrual period or estrogen dominance issues. Progesterone may or may not need to be replaced on the latter half of the cycle, as long as monthly bleeding continues. Some women find that Estriol replacement beautifully lifts them out of a depression that seemed unexplained.

It would be remiss not to mention testosterone. Testosterone levels also decline as women age. About 30% to 40% of women seem to be affected by this decline. Feelings of fatigue, lowered libido, difficulty concentration and depression can often be due to a decline of testosterone and bio-identical replacement can be helpful. Many women describe an overall feeling of contentment with testosterone replacement, making it helpful for mid life depression. This is especially true for women who have had a hysterectomy as their levels are lower than women who have not. Testosterone converts into estrogen, and it is easy to get too much of this hormone, so replacement needs to be monitored carefully.

Many things can contribute to depression at mid-life: high stress levels, lack of exercise, poor diet choices, or unhappiness at home or work. The initial decline of hormones is exacerbated when women are out of balance. Before considering replacement with bio-identical hormones, try these simple steps: