This paper examines the impact of women's health in relation to stress factors and everyday life.  More often than not, at the core or root of women’s health concerns are elevated levels of stress often associated with our modern world (Welch, C. 2011).  Stress may be derived from emotional or physical confrontations in the home, community or work setting, or it may be simply the constant ringing of the phone or emails in our fast paced world.  When the body perceives stress, a fight-or-flight response kicks in and with it a surge of cortisol, a hormone, is released as part of a self defense mechanism.  Too much chronic stress induced cortisol can create a dangerous downward spiral of health effects.

What are hormones?  “Hormones are the chemical messengers of the endocrine system… and their receptors regulate a great many basic processes, including metabolism, appetite, sleep/wake cycles, reproduction, and stress management” (Rappolt-Schlichtmann, G, et al, 2010, p157).  Furthermore, hormones  control, energy production and storage, water and salt metabolism, and growth.  Hormones have the ability to turn on or off genetic genes at the molecular level, while they also help to protect cells and steer immune functions (Kaman, B. 1995).  Glands including the adrenals, hypothalamus, pancreas, parathyroid, pituitary, pineal, ovaries (in women) and testes (in men) are responsible for the manufacture of hormones through the utilization of amino acids, proteins, peptides and cholesterol (Kaman, B. 1995).  This picture paints the importance of hormonal balance and healthy well-being.

Through the lenses of women across recent generations, it becomes clear that our grandmothers and great grandmothers did not suffer from PMS, menopause, osteoporosis, or breast cancer all of which are plaguing women today so commonly as to be expected or thought normal, however, healthy women do not suffer these consequences (Kaman, B. 1995).  A lot has changed in recent times including the quality of air we breath, the water we drink, and food we eat, the pesticides we are exposed to, not to mention the pharmaceuticals we consume.  Furthermore, we are bombarded today with a typical indoor work environment, artificial lighting and host of stressors and complaints that come with work force demands typical of todays 40 or more hours work time each week in the United States.  A recent study in Sweden follows 68 nurses working only 6 hours a day.  Compared to the control group, the nurses with reduced work demand hours were less likely to take time off, they took half as much sick time, they were 20% happier, and they were 64% more productive on the job (Greenfield, R. 2016).  The bottom line is that women today are struggling to be healthy, to balance their hormones, and at the root of all of this begs for stress reduction.

Let’s take a closer look at women's hormonal functions (note women and men have the same hormones but in differing quantities).  Progesterone, manufactured primarily in the ovaries and also from the adrenal glands, and during pregnancy the placenta, is the platform for the creation of all other steroid hormones and includes sex hormones and corticosteroids (Kamen, B. 1995).  Progesterone is most known for its preparations in fertility and early pregnancy.  Beginning with ovulation around the 14th day of the menstrual cycle progesterone increases through the luteal phases and if an egg is not fertilized, progesterone will drop off and a new menstrual cycle will begin.   Progesterone is known to enhance mood and is particularly evident during during elevated levels of progesterone in pregnancy, thus if an egg is not fertilized, progesterone will drop and low levels are associated with PMS mood swings (Kaman, B. 1995).  Estrogen can be produced by any cell in the body and by the adrenal glands and its main role is to build and nourish the body (Welch, C. 2011).  Estrogen helps to regulate the menstrual cycle, controls growth of the uterine lining, plays a big part in the constant dynamic change and regrowth in our bones, and estrogen manages the brains neurotransmitters and serves as an antidepressant (Kaman, B. 1993).

When considering women’s sex hormones, ratio is important and progesterone assumes the role of balancing estrogen.  Estrogen dominance during the luteal phase, or the second half of the cycle is problematic.  Even if estrogen levels are too high, as long as there is enough progesterone during the luteal phase, the required ratio will be maintained and excess estrogen will be displaced by progesterone.  On the other hand, if estrogen levels are low in the luteal phase, as they should be, and if progesterone levels are also low, estrogen will problematically dominate (Kaman, B. 1995) resulting in increased PMS, and change of quality or quantity of menstrual cycle, including potentially heavy (Kaman, B. 1995) or dangerous menorrhagia hemorrhaging.  Therefore correct ratio of progesterone to estrogen is imperative to maintain a healthy cycle.

What causes estrogen dominance?  Or perhaps we should consider what causes progesterone deficiency?  The answer lies in stress and the production of cortisol.  Adrenaline and cortisol, produced in the adrenal gland, provides the body with the very important survival ability to fight-or-flight in response to stress.  Adrenaline provides a short term stress response while cortisol remains active longer.  When we have chronically high levels of cortisol from constant stress in our lives, the effects of an adrenaline surge can last longer too (Welch, C. 2011).  With chronic stress our adrenal glands become fatigued and unable to perform their important work.

Recall that I mentioned progesterone is the platform for the creation of all other steroid hormones.  In fact progesterone can be used to manufacture sex hormones like estrogen as well as stress hormones like cortisol.  A problem arrises when we have “stress hormones like cortisol coursing though our bodies on a regular basis.  The crunch comes when we don’t have enough of these hormones available to satisfy the hug demand for them… One way to get more is to sacrifice some of our sex hormones by transforming them into stress hormones… progesterone can become cortisol” (Welch, C. 2011, p25).  When you are experiencing chronic stress resulting in adrenal fatigue, your body cannot produce enough stress easing hormones and therefore it turns to sex hormones and converts progesterone to cortisol (Kamen, B. 1995).  Thus the vicious cycle of low progesterone and upset menstrual cycles begins.  Interestingly, a study investigating “the effect of stress on estradiol, progesterone, and cortisol levels in women during the follicular phases of the menstrual cycle… found that physical stress (the cold pressor test) had no effect on estradiol levels, but increased progesterone and cortisol… One interpretation of these finding is that higher progesterone (P) levels during certain phases of the menstrual cycle leads to greater free cortisol levels in response to stress” (Herrera A. Y. et al, 2016, p96).  That is, higher levels of progesterone allows the body to produce increasing amounts of cortisol during stress. 

If reducing stress and cortisol presence is not enough to balance women’s progesterone levels and the progesterone estrogen ratio, women are commonly assigned hormone replacement therapy.  It is found that synthetic progestins decrease the bodies ability to manufacture natural progesterone and so the condition of low progesterone is actually worsened (Kamen, B. 1995), alternatively it is recommended that one uses transdermal natural progesterone cream (Kamen, B. 1995), as hormones are often not absorbed well through the digestive tract.  Furthermore, studies indicate that estrogen replacement therapy with or without synthetic progestogens, or synthetic progestogens alone come with side effects and increase ones risk of breast cancer, while a safer option eliminating the risks of side effects is transdermal use of natural progesterone” (Kamen, B. 1995, pp. 206-207).  In fact, natural progesterone cream has many protective and balancing benefits including decreased risk of fibrocycts, efficient energy metabolism, thyroid stimulation, antidepressant, libido, blood sugar balancing, cancer prevention among other things (Kamen, B. 1995).  Furthermore, “vitax is the single most important western herb for regulating the period and reducing menopausal distress.  Vitex stimulates the pituitary and helps the body produce progesterones.  This herb has a balancing effect on estrogens while favoring progesterone” (Kamen, B. 1995, p 234).  Not all medical doctors are well educated on natural progesterone and herbal options.  It is important that women seek knowledge of options and share information about alternatives with their medical practitioners.  While hormone replacement therapy may be necessary for some women, natural approaches may satisfy others and serve as a safer starting place.

Let’s revisit the idea of estrogen dominance.  It is possible to have too high estrogen, and unless there is enough progesterone to balance this ratio, risks associated with estrogen dominance will prevail.  In other words, one could have increased levels of estrogen and normal or low levels of progesterone and therefore estrogen dominance.   One such cause of high estrogen is hypothyroid.  Having low thyroid hormone means that progesterone is not managing estrogen well and therefore it is possible to have a higher level of estrogen throughout the body (Kamen, B. 1995).  Note the thyroid and adrenal glands work closely together to keep your body functioning.  Low thyroid is often experienced as fatigue similar to adrenal fatigue.  In this case it is recommended that one look at thyroid hormone levels as well as pituitary hormone levels to determine if one has hypothyroid (Kamen, B. 1995).  Another common thread today is MTHFR a genetic defect which renders one inefficient in detoxification processes, environmentally sensitive, and therefore, it is not uncommon for women with MTHFR to end up with high levels of estrogen (Ledowsky, C. 2016, and Camahan, J. 2013).  In the case of MTHFR, careful supplementation and cleansing may be in order.  Recall that estrogen favors growth, “‘the hormone of life.’  This conveys an idea of the power of estrogen but also its danger in the context of cancer’.  There is no question that excessive estrogen may increase the risk of endometrial cancer… We must understand that estrogens don’t initiate cancer; they can, however, promote it” (Kamen, B. 1995, pp. 98-99).  Therefore, estrogen at levels too high increases ones risk of estrogen sensitive cancers.

Stress hormones have far reaching negative effects beyond disrupting women’s delicate balance of sex hormones. Cortisol plays important roles beyond fight-or-flight survival response.  Cortisol manages the metabolism, blood sugar balancing, and ideal weight, (Welch, C. 2011).  Chronic high and low blood sugar caused by an imbalance in cortisol levels can lead to hypothyroid  (Kresser, C. 2010).  As previously mentioned hypothyroid can lead to estrogen levels being too high, risk of estrogen sensitive cancers, and so on.  High levels of cortisol can cause cardiovascular disease and is specifically a predictor of clogged  heart vessels (Cutler, W. B. 2009).  As though these concerns are not enough, chronic increased cortisol levels is known to cause memory impairment and shrinking of the brain, according to Sonia Lupien, PhD a specialist in aging and Alzheimer’s disease research (Cutler, W. B. 2009).  “In addition to clinical evidence, there is experimental evidence that high levels of cortisol alter memory function.  Patient populations with chronically elevated levels of cortisol, such as Cushing’s syndrome, major depression, and schizophrenia, as well as asthmatic patients treated with the glucocorticoid prednisone are characterized by impaired memory function (Starkman et al. 2992; Marui et al. 1993; Keenan et al. 1995; Sheline et al. 1999; Saposky 2000; Rasmusson et al 2001)” (Payne J. D., Nadel, L. 2017, p657).  Furthermore, high levels of cortisol negatively effect the bodies immune response and infection fighting capabilities, not to mention bone density and osteoporosis, (Welch, C. 2011).  In fact a discussion of bone density and osteoporosis and its relation to steroid hormones is worthy of an entire research report of its own magnitude.  “Sadly, another source of stress hormones, if a women is pregnant, is from her developing child.  Studies have shown that an unborn baby’s adrenal glands may enlarge substantially in utero to supply its mother with the stress hormones that her body is demanding…. if a child is born with already overtaxed adrenal glands… she may have a naturally lower tolerance for stress and be especially prone to a hypersensitive nervous system” (Welch, C. 2011, p25).  Clearly becoming stress resistant is imperative if we are to allow for our body to maintain a balanced hormonal system necessary for a healthy body function, and furthermore, to protect of an unborn child from the ill effects of chronic stress. 

Adequate and quality sleep is a must.  Too little sleep creates fatigue, and if left unchecked for too long our adrenal glands will wear out and be unable to produce enough steroid hormones (Welch, C. 2011).   Proper nutrition is imperative.  Green leafy vegetables are the best source of calcium and collagen for building strong and flexible bones (Kamen, B. 1995).  Healthy fats including extra virgin olive oil, cold pressed coconut oil, avocado, hemp and flax seeds are also an important part of a healthy diet and provide building blocks for manufacturing hormones.  Fermented vegetables are by far a super food, an immune supporter, known to fight cancer (Thomas, J. P. 2017), and a digestive aid and an amazing source of manufactured vitamins and minerals.  Fermented dairy is lower lactose and more tolerated by a large part of the population.  Avoidance of sugar, soda, coffee, (Kamen, B. 1995) as well as pesticide laden foods, is ideal as these are pro inflammatory foods, and inflammation is at the root of most disease (Appleton, N. 2005).  Furthermore, fruit should be eaten fresh and whole as nature intended, whereas fruit juice has too high of a sugar content (Kamen, B. 1995).  Animal protein should be eaten in moderation, it is among the most difficult food to digest.  Too much protein in general demands calcium be drafted from the bones leading to decreased bone mineral density (Kamen, B. 1995), and it is not oncoming for a western diet to over consume protein.  Certainly the topic of nutrition and its relation to steroid hormones is worthy of an entire book as well.  Additionally, outdoor sunshine exposure is very important for vitamin D synthesis, and combined with exercise and weight-bearing activities, the bone building process is supported (Kamen, B. 1995).  Finally, mindfulness-based stress reduction (MBSR) developed by Dr. John Kabat-Zinn, focusing on being in the present moment,  with a nonjudgemental and accepting attitude (Cutler, W. B. 2009), is a recommended life approach to optimize stress resiliency.

In conclusion, understanding women’s sex hormones and the vicious cycle of stress hormones is a topic as vast and deep as they come.  My findings in this article represent only the tip of an ice berg and yet are very revealing to the importance of stress reduction and the need for proper body care.  Further discussion of MTHFR and other genetic changes, bone health, and nutrition, are certainly worthy of further investigation in understanding the complexities of women's health.  The bottom line is stress reduction, adequate and quality sleep, proper nutrition, exercise, and positive life approach through mindfulness will aid in optimizing our healthy balance.





References


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Camahan, J. (2013, May 12). MTHFR gene mutation… what’s the big deal about methylation? Retrieved

from http://doccarnahan.blogspot.com/2013/05/mthfr-gene-mutation-whats-big-deal.html


Cutler, W. B. (2009). Hormones and your health. Hoboken, NJ. John Wiley & Sons


Greenfield, R. (2016, June 6). The six-hour work day increases productivity. so will Britain and America

adopt one? Retrieved from http://www.independent.co.uk/news/business/the-six-hour-work-day-

increases-productivity-so-will-britain-and-america-adopt-one-sweden-a7066961.html


Herrera, A. Y., Nielsen, S. E., Mather M. (2016). Stress-induced increases in progesterone and cortisol in

naturally cycling women. Neurobiology of Stress. Volume 3. pp. 96-104


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Welch, C. (2011). Balance your hormones, balance your life. Cambridge, MA. Da Cap Press

Surrounding ones life with positive relationships, relationships inspired with optimism, and hope, welcomes the good life.  “Life’s truly joyful and meaningful moments are spent in the company of others… Our bonds with others are ‘the best antidote to the downs of life and the single most reliable up,’ he [Seligman] says.  ‘And research literature shows that loneliness is one of the huge factors in anxiety and depression.  Human beings are built for relationships’” (Hooper, J. 2001, p100).  Mindfulness and clear communication may be necessary tools to ensure rewarding relationships, and enhance an overall sense of wellbeing.   When blessed with a good challenge of parenting a strong willed child, a mindful approach to a positive parenting relationship may especially be imperative.

Negative relationships may render one feeling unheard, alienated, and isolated, thus experiencing stress capable of impacting ones very health.  A study among China women found that that stressors from work or the family home were positively associated in incidence of asthma, and when work and family stressors were combined asthma occurrence was further correlated (Loerbroks, A., et al, 2017).  Another China study of older populations experiencing mobility impairment, and therefore fewer social engagements, found they were more likely to report lower life satisfaction (Li L., Loo B. P., & Y, 2017).  Additionally, a study of women in China and Hong Kong positively correlated support from work supervisors and family support with increased life satisfaction (Drummond, S., et al, 2017). Though, this study did not show the same life satisfaction trend with Australia and New Zealand women, directing the need to continue studying gender and cultural differences (Drummond, S. et al, 2017).  Further highlighting the importance of positive social relationships is a study that focuses on women and their sense of social safeness.  Findings showed that women with positive relationships and higher levels of social safeness were positively correlated with increased self respect and attitude towards ones body resulting in lower occurrences of eating disorder behaviors (Pinto, C., et al, 2017).  These studies and many more demonstrate the importance of surrounding ones life with positive relationships resulting in a greater sense of well-being and health.

More specifically, dysfunctional romantic relationship studies document correlation with psychological and physiological health problems, whereas positive relationships or romantic competence (RC), displayed greater satisfaction, security, respect, good communication, and a positive or optimistic outlook towards another person, all associated with fewer negative symptoms (Davila, J., et al, 2017). 

“Davila et al. (2009) originally described RC as having three components: (a) the ability to think about relationships with a consideration of mutuality, in a thoughtful, insightful way, that shows learning from experience, and consequential thinking; (b) the ability to make decisions and engage in behaviors that maintain care and respect of self and others and can be successfully dealt with emotionally; and (c) the ability to regulate emotions and the self in response to relationship experiences.” (Davila, J., et al, 2017, p163). 

Greater RC is associated with emotional regulation, specifically healthier decision making, and less occurrence of depression and anxiety for both genders (Davila, J., et al, 2017).  Davila, J., et al (2017) further stresses the importance of promoting healthy positive relationships beginning at a young age to prevent physical and mental problems and encourage a healthy life.

Nearly a million students are identified to receive special education services, and the majority are diagnosed with attention deficit hyperactivity disorder (ADHD) (Henley, M., 2010).  Parenting special needs children, strong willed, or challenging children can be emotionally draining to the parent, is associated with increased parental anxiety (Petcharat, M., & Liehr, P., 2017) and may negatively affect psychological well-being, daily activities, family and romantic relationships, and overall quality of life (Cappe, E., et al, 2017).  Specifically,

“Many researchers (Bailey, Golden, Roberts, & Ford, 2007; Singer, 2006; Thurston et al., 2011) have reported a high incidence of psychological problems in parents who have children with special needs. Thurston et al. (2011) reported that 42% of the surveyed parents of children with special needs presented symptoms (mild to severe) of psychiatric distress… 29% of the mothers of children with developmental disabilities have elevated symptoms of depression (Singer, 2006). Bailey et al. (2007) also reported that 12–15% of mothers having a child with disabilities have clinical depression.” (Petcharat, M., & Liehr, P., 2017, p1). 

In general special education students require positive behavior support programs to succeed (Henley, M., 2010).  Cappe, E. et al (2017) recommends parenting skill programs to support families.  Positive parenting, mindfulness practice, and clear communication can certainly help to promote positive relationships not only in the strong willed or special needs child relationship, but across the board in all relationships.

Interpersonal positive behaviors, such as clear communication and quality listening (Lynn, S. J., et al 2015, pp. 324-325) may serve as a foundation for all positive relationships. Active listening with full attention and the ability to repeat back to the speaker what was expressed allows one to feel heard and validated (Lynn, S. J., et al 2015, p.333). Use of the X-Y-Z model “When you do [X (a specific behavior)], during [Y (a specific situation)], I feel [Z ( an emotion)]” (Lynn, S. J., et al 2015, p.333) promotes clear communication.  In the eyes of a child, clear intentional communication with direct statements and explicit expectations (Lynn, S.J. et al.2015,p380) increase the likelihood that a child will make good choices and display pro social behavior (Lynn, S.J. et al.2015,p380).  Catching children in the act of pro social behavior and highlighting such moments with immediate praise and positive touch (Lynn, S.J. et al, 2015) is recommended to support positive relationships.  Furthermore, using positive reinforcements, and natural and logical consequences such as reprimands, or when possible behavior ignoring, will draw more attention to pro-social behaviors (Henley, M. 2010).  In general, taking responsibility for clear communication, being an active listener, not blaming the other person, finding empathy for the other persons perspective, and working constructively together to solve problems (Davila, J., et al, 2017) supports positive relationships including RC.

Taking a mindfulness approach towards other people and situations models pro social positive relationship behavior.  Mindfulness-based stress reduction (MBSR) research covering a variety of populations has demonstrated reduced negative outcomes of stress, anxiety and depression while promoting a healthier sense of overall well-being (Petcharat, M., & Liehr, P. 2017).  “Duncan, Coatsworth, and Greenberg (2009) also explain a model of mindful parenting as ‘the awareness that emerges through paying attention, on purpose, in the present moment, and nonjudgmental to the unfolding of experience moment by moment’ (p. 255) in the social context of parent-child relationships” (Petcharat, M., & Liehr, P., 2017, p2).  Neece (2014) MBSR study findings report significantly less stress and depression, and increased life satisfaction (Petcharat, M., & Liehr, P., 2017).  Furthermore, Grossman et al’s (2004) meta-analysis of health-related MBSR included populations with anxiety, depression, pain, cancer, and heart disease, and demonstrated evidence supporting MBSR ability to minimize negative psychological and physiological affects (Lynn, S., J., 2015).  Thus, when we bring mindfulness to our everyday lives and strive to always remain in this present and nonjudgmental consciousness we may enhance positive relationships benefiting our overall well-being.  Furthermore, when we model mindful practice to children and any human being, we promote their well-being too.

To conclude, negative relationships tend to create stressors and decline of health, while positive relationships may enhance ones healthy outcome and general life satisfaction.  Specifically, positive relationships in the workplace, the family home, or romantically may be promoted through clear communication and mindfulness practice, contributing to physiological and phycological well-being for all parties.  In the wake of parenting the special needs or strong willed child, through acquiring the necessary tools to assist such challenging child-parent relationships, one may reduce stressors and anxieties.  Special attention towards fostering parenting skills through professional direction, and especially paying attention to clear communication and mindfulness practice may enhance rewarding and healthful positive relationship outcomes for families.  Thus, time and investment in developing positive relationships across a variety of settings has beneficial outcomes of a life well lived.




References:

Cappe, E., Bolduc, M., Rougé, M., Saiag, M., & Delorme, R. (2017). Quality of life, psychological characteristics, and adjustment in parents of children with attention-Deficit/Hyperactivity disorder. Quality of Life Research, 26(5), 1283-1294. Retrieved from doi:http://dx.doi.org/10.1007/s11136-016-1446-8

Davila, J., Mattanah, J., Bhatia, V., Latack, J. A., Feinstein, B. A., Eaton, N. R., . . . Zhou, J. (2017). Romantic competence, healthy relationship functioning, and well‐being in emerging adults. Personal Relationships, 24(1), 162-184.  Retrieved from doi:http://dx.doi.org/10.1111/pere.12175

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Hooper, J, (2011). Flourish. Whole Living Body & Soul in Balance. Vol. May, pp.98-103.

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Loerbroks, A., Ding, H., Han, W., Wang, H., Wu, J., Yang, L., . . . Li, J. (2017). Work stress, family stress and asthma: A cross- sectional study among women in china. International Archives of Occupational and Environmental Health, 90(4), 349-356. Retrieved from doi:http://dx.doi.org/10.1007/s00420-017-1201-7

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