Hormone Imbalance and Addiction

Addiction is a demon that plagues many of your patients, friends and even colleagues on one level or another. The etiology of addiction is complex; as there is at least a genetic component, a behavioral factor, a social aspect and of course a biochemical piece. When treating addiction it is important to address as many of these as possible. Reproductive hormones are very closely tied to neurochemistry including modulating serotonin, dopamine, histamine and other neurotransmitters. A hormonal shift may create and can certainly exacerbate any neurotransmitter imbalance.
Estrogen dominance, a state where there is a greater influence of estrogen than progesterone on the body is alarmingly common in women of all ages. In peri-menopausal women, their progesterone levels fall many years before the decline in estrogen levels creating a state of relative estrogen dominance. One of the many actions that progesterone has on the body is to calm electrical activity in the brain. The primary mechanism for this is through the metabolite allopregnenolone which activates the same GABA-A receptor as Valium, Xanax and alcohol. Without the relaxing effect of progesterone, many women find themselves with new-found anxiety or insomnia and may self medicate with one of the above mentioned substances. Furthermore, estradiol exacerbates the situation by enhancing the excitatory neurotransmitters dopamine, and histamine. The combination of increased excitation and diminished inhibition of electrical stimulation is often enough to push many women over the edge and into addiction. Although women in the peri-menopausal years is often where we see this phenomenon, please remember that there are many younger women and even adolescents with inadequate progesterone levels that may predispose them to reach for an exogenous source to relax them, or shut down some of their overactive neurotransmitter activity.
As in many situations, too much estradiol (relative to progesterone) causes significant problems, but too little estradiol can also wreak havoc on brain chemistry. Estradiol inhibits the enzyme monamine oxidase (MAO) which is responsible for breaking down serotonin, dopamine and histamine and estradiol enhances the serotonin receptor function in the female brain. As estradiol levels fall to below optimal levels (as with anovulation or menopause), many women can suffer from anxiety and depression due to diminished serotonin, histamine and/or dopamine levels. There are a number of substances that enhance dopamine and/or serotonin activity in the brain including food, nicotine, alcohol, opioid pain medications and marijuana.Evaluating and treating hormone deficiencies and imbalances is an important part of a comprehensive and holistic treatment for addiction as well as the underlying conditions of anxiety and depression.