Jun 11, 2009
I contacted a Compounding Pharmacy in St. Joseph and the Pharmacist gave me the name of the only MD he knows who specializes in BHRT. I am waiting to hear from that office for an appointment.
I found an article on Florida Detox Center website that focuses on the vulnerability of women to Alcohol and Opiate abuse. They state that their clinical studies indicate that addicted patients utilize drugs and alcohol either to stimulate under-active brain regions or to relax over-active brain systems. The aberrant electrical activity in the addicted patient's brain is typically caused by inherited or acquired biochemical and hormonal deficiencies.
Below is an excerpt from the article by Marvin (Rick) Sponaugle, MD of the Florida Detox Center:
Correcting hormonal deficiencies can eliminate various addictions that are prevalent in the middle age female population. The average age of menopause in American women is 51 years; however, the decline of female hormones is usually a gradual process with progesterone levels starting to decline approximately eight years prior to that of estrogen. Northrup, C. (2006) When progesterone production declines in middle age females, they begin to experience new found anxiety and insomnia. Retrospective clinical studies at Florida Detox and Wellness Institute have demonstrated that the "progesterone drop out" phenomenon is a common etiology of alcohol and drug abuse, with causation in over forty percent of our addicted middle age females. Amazingly, the majority of these progesterone deficient females have never had hormonal evaluation by their doctors.
The biochemical explanation for the increased anxiety experienced by midlife females is that suboptimal progesterone levels occurring in the presence of normal estradiol levels cause an increase in brain electrical activity. Progesterone essentially is a brain relaxing hormone because it converts to another hormone, allopregnanolone. This metabolite of progesterone, allopregnanolone, activates the same "relaxing" nerve receptor, the GABA-A receptor, as does Valium, Xanax and alcohol. Torres and Ortega (2003)
When females experience a loss in GABA activity from diminishing progesterone levels while maintaining normal estradiol production, they can develop excess electrical activity in both, their central and peripheral nervous system. This phenomenon occurs because estradiol enhances the excitatory brain chemicals, dopamine and histamine. Their excitatory effect on brain electricity should be counter balanced with the GABA effect of progesterone. The new onset progesterone deficient middle aged female experiences newfound anxiety and insomnia that frequently precipitates the need for relaxing medication which ultimately causes subsequent addiction issues.
Alcohol activates the GABA-A¾receptor like Valium. The woman who historically drank only one glass of wine with dinner will insidiously progress, normally over a few years, to two bottles of wine per night. The wine, once a social drink, has now become "medication."
She may be courageous enough to visit her physician, however, if the physician has limited knowledge regarding the importance of hormonal replacement therapy, he/she will have even less biochemical knowledge regarding the powerful effect of estradiol and progesterone on brain function, specifically the hormonal effect on brain neurotransmitters like dopamine, histamine and serotonin. Her doctor may not appreciate the gravity of the patient's situation, however, will frequently practice "symptom medicine" and readily prescribe her addicting medication such as Xanax or Klonopin, a quick and easy medical maneuver verses investigating her hormonal imbalance.
Another common scenario observed at Florida Detox is that the new onset progesterone deficient female will begin to abuse Vicodin or Oxycontin. Vicodin is now easily ordered over the internet from unscrupulous pharmacies allowing easy access without physician consultation. The opioid pain medications block something called the calcium channel in nerves which is why we use them to decrease the electrical current of pain. This blockade effect ameliorates the increased "brain voltage" derived from loss of the progesterone.
Unfortunately, when she chooses this option, she will eventually develop Mu receptor tolerance, begin increasing her 24 hour opiate dose and subsequently develop hypothalamic-pituitary-ovarian axis suppression further exacerbating her original hormonal deficiency. Santen, F. et al. (1975)
Fortunately, when progesterone levels are restored using bio-identical progesterone, the anxiety and insomnia disorders subside, patient "craving" for alcohol or drugs like Xanax and Vicodin stops.
The relaxing GABA effect of the progesterone metabolite, allopregnanolone, is much more critical for balancing brain electrical function once estrogen production has been activated by the ovaries. Estradiol inhibits the metabolism of dopamine, histamine and serotonin and therefore increases brain electricity. Specifically, estradiol inhibits the enzyme, monoamine oxidase, which is responsible for the metabolism of serotonin, dopamine and histamine. Histamine is an excitatory neurotransmitter that activates brain electricity in much the same fashion as dopamine.
...estradiol deficiency. Estradiol enhances serotonin receptivity, the ability of serotonin to activate the serotonin receptor, in the female brain. Kugaya, A. et. al. (2003), Fink, G.et.al. (1996)
While the medical literature states that "normal" estradiol levels fluctuate during the menstrual cycle between15 pg/dl and 315 pg/dl, estradiol levels below 60 pg/dl cause compromised serotonin receptivity, or decreased ability of serotonin to activate the serotonin receptor. Also, as stated above, estradiol inhibits monoamine oxidase, the enzyme that metabolizes monoamines and therefore increases brain activity of serotonin, histamine and dopamine. Klaiber, E., et. al. (1996)
Knowledge of these biochemical principles facilitates understanding of the common symptoms associated with premenstrual syndrome, post partum depression, and the midlife onset of psychological issues such as depression, anxiety and insomnia in the female gender. It becomes then obvious that untreated estradiol deficiency plays a pivotal role in causation of new onset addiction issues in middle age females. Why are these hormones not routinely measured by addiction treatment centers?
The increased anxiety associated with suboptimal serotonin activity has so eloquently been elucidated by my esteemed colleague and friend, Daniel Amen, M.D., the founder and medical director of the Amen Clinics.
Through SPECT brain imaging, Dr. Amen has demonstrated that patients with suboptimal serotonin activity, whether inherited or acquired suffer from excess activity in two distinct regions of the brain, the limbic system or "emotional center" and the anterior cingulate gyrus, normally considered the brain's gear shifter.
Furthermore, normal serotonin activity inhibits the release of the excitatory neurotransmitter, norepinephrine or noradrenaline, ninety percent of which is derived from the brain and ten percent which is derived from the adrenal glands. Excess release of norepinephrine from the central brain nucleus, the locus coeruleus, occurs when serotonin receptivity is compromised by estradiol deficiency.
These female patients can develop excessive sympathetic tone in both the central and peripheral nervous systems, suffering exacerbation of underlying anxiety and insomnia disorders from the central effect and increased physical pain from the elevated electrical current in peripheral nerves. These patients, if not correctly diagnosed and treated, have multiple reasons to self-medicate with pain pills, Xanax like drugs and alcohol. Talk therapy and Twelve Step addiction treatment will not change the biochemical and neurological effect of this female hormonal imbalance.