Histamine, hormones & HRT
We know all too well that perimenopause is a moving target. Progesterone declines, but oestrogen can fluctuate wildly with periods of higher oestrogen resulting in symptoms such as heavy periods, breast pain or soreness, low mood, irritability, rage, migraine, hot flushes and insomnia.
There’s another player that can add to the havoc of perimenopause: histamine.
We are most familiar with histamine causing allergy-type symptoms and the need to reach for anti-histamines in the presence of pollen, dust or animal fur.
But do you know that oestrogen stimulates histamine release in the body and downregulates the operation of the histamine-clearing DAO enzyme? This has two important outcomes:
A potential increase in histamine-related symptoms such as nausea, diarrhoea, heart palpitations, itching, anxiety, breathlessness, indigestion and severe headaches during periods of higher oestrogen.
The production of even more oestrogen because too much histamine stimulates the ovaries to make more oestrogen. This extra oestrogen then stimulates the immune system to release more histamine and on the vicious cycle goes.
The vicious cycle of oestrogen & histamine.
This relationship between oestrogen and histamine may explain (at least in part) the severity of PMS, period pain and heavy periods. This is a topic which I will return to in my posts on the parallels between puberty and perimenopause and the steps you can take to support the hormonal health of both yourself and your teenage daughter (follow @midlife_management on Instagram for updates).
The relationship between oestrogen and histamine may also explain why some women struggle to settle into their HRT regime and find new symptoms occur or existing symptoms get worse once they start HRT. These symptoms may come and go depending upon the contents of your personal “histamine bucket”. This is a phrase which refers to the many factors which contribute to your individual histamine burden at any one time:
The contents of your histamine bucket can vary from day to day, therefore, symptoms driven by your histamine burden can come and go and can take you by surprise.
Your decision to take HRT will have been made carefully in conjunction with your GP or menopause specialist. Therefore, the answer is not to take HRT out of your histamine bucket and let that be an end to it. Your first port of call should be your GP or menopause specialist - they may wish to adjust the dose or the form of your HRT to manage your symptoms more effectively. If your symptoms persist despite adjustments, I can then help you to work out whether an overflowing histamine bucket is contributing to your symptoms. This requires a personalised, focused approach. The idea is to manage the contents of your personal histamine bucket, so that HRT does not make it overflow.
Together we will address questions including:
Is there a connection between your intake of foods or drinks containing histamine and your symptoms?
Do you have any food sensitivities which may add to your histamine load?
Are your symptoms worse at certain time of the year or in different environments?
Are you taking any supplements which may add to your histamine burden?
Is vitamin deficiency a factor for you?
Is your liver health optimal or do you show signs of suboptimal liver function such as headaches and sensitivity to smells?
Is your gut health optimal or do you show signs of imbalanced gut bacteria such as bloating, difficult to pass stools or diarrhoea?
Are you taking any medications (such as antidepressants) which may effect the operation of the DAO enzyme which breaks down histamine?
What can we do to reduce the contribution of stress to your histamine bucket?
We may also consider the merits of genetic testing to establish whether SNPs on genes coding for oestrogen receptors or the DAO enzyme (which breakdowns histamine) are impacting your ability to benefit from HRT. If so, we will factor that in to your personalised plan of action.
If you would like to talk about working with me, please do book a free Zoom call:
Sources:
Bonds, R.S. and Midoro-Horiuti, T. (2013) “Estrogen effects in allergy and asthma”, Current Opinion in Allergy and Clinical Immunology, 13(1), pp. 92-99.
Schnedl, W.J. et. al. (2019) “Evaluation of symptoms and symptom combinations in histamine intolerance”, Intestinal Research, 17(3), pp. 427-433.
