It’s natural for women to slowly lose reproductive capability as they age. Hormones driving childbearing years begin to wane, a transition that can happen smoothly for many women. Yet other women may experience great upheaval and numerous negative symptoms that seriously affect their daily lives. Despite a severely diminished quality of life, many women suffer in silence and do not seek treatments from the professionals who can help them the most.
Menopause can be a confusing time. The condition may cause many physical, emotional, and mental symptoms that could also be attributed to a variety of other conditions. Skilled professionals can help positively identify symptoms coming from menopause through testing, and select appropriate treatments to address the true underlying issues.
Menopause – A Winding Down of Reproductive Function
During her 40s or 50s, a woman’s body slowly stops producing the menstrual cycle hormones that allow her body to become pregnant. During the menstrual cycle, the hormone estrogen triggers the uterus lining to grow thick each month, and if conception is not achieved, it is sloughed off as her period. During the second half of the menstrual cycle, progesterone is produced, which continues to thicken the uterine lining.
As she ages, a woman produces fewer of these hormones until her menstrual periods cease. Menopause is defined as 12 months of having no period, though women can have abnormal cycles for many years before they finally stop. The average age of menopause in the U.S. is said to be 51 years of age (1), though it may happen many years sooner or later.
It is the low amount of estrogen that appears to drive many of the uncomfortable or even alarming symptoms that women experience in the years leading up to and during menopause. Estrogen is not only a big piece of the reproductive cycle, but it is also involved in the maintenance of healthy bones, blood vessels, mood, cognitive health, and the control of internal temperature (2). When estrogen levels drop, that’s when many women will begin to suffer from various symptoms.
SYMPTOMS OF LOW ESTROGEN
Hot flashes - dysregulated temperature: In this extremely common symptom of menopause, low estrogen affects the internal thermometer, causing a sensation of sudden, intense heat. Sometimes the skin will flush red as heat is experienced. This symptom has been known to severely disrupt the sleep cycle, causing a cascade of negative symptoms.
Thinning tissues: The delicate tissues of the outer vagina and vaginal canal begin to thin and lose elasticity without the supply of estrogen, in a condition known as vulvovaginal atrophy (VVA). The production of moisture for these tissues begins to decrease. These symptoms can combine to cause pain during intercourse and even spotting afterward. VVA is one of the most common yet under-reported symptoms of menopause (3). Naumova et. al calls the under-reporting of this symptom a “silent epidemic” that affects almost half of postmenopausal women (4).
Urinary issues: If lack of estrogen is causing VVA, the symptoms can express as burning or pain upon urination. This can be accompanied by a sense of urgency or even bladder incontinence. Increased likelihood of urinary tract infections may also result.
Mood variability: Hormones can affect mood directly or indirectly (such as through loss of sleep due to hot flashes). Depression, anxiety, or irritability are often reported.
Weakening of bones: Over the long term, low estrogen levels are associated with less robust bones and an increased risk of osteoporosis (5, 6).
Diseases of the blood vessels and heart: Long-term, low levels of estrogen appear to increase the risk for heart disease and stroke (6).
NATURAL APPROACHES TO BALANCING HORMONES
Mastering the Basics: Laying the Groundwork for Optimized Hormones
Many interventions can help prevent menopause symptoms. The list below may look familiar because they are practices that help maintain a strong, resilient body and a sound mind. Hormones can become imbalanced by a lack of nutritious food, poor sleep, and high stress, so it is vital to master the basics. Please see our article that addresses the 5 Pillars of Health for more information about mastering these vital basics.
Exercise balances hormones - Simply walking for 20 to 30 minutes several times a week is an effective way to help balance hormones and minimize the symptoms of lower hormones after menopause, especially if done in the sunshine at the same time every day. Walking fast, then walking slowly in repeated cycles using the High Intensity Interval Training (HIIT) method ramps up metabolism, burns excess blood sugar in the system (improving insulin sensitivity) (7), and improves cardiovascular fitness (8). The improved efficiency of detoxification from exercise can remove toxic substances in the body that can negatively affect hormones, such as heavy metals. Walking can even be done in place, at home, as these videos demonstrate. Nothing beats the increased oxygenation, improved detoxification, and improved mental state that regular exercise can provide.
Good sleep - As explained in our series on sleep, a good night’s rest is vital to great health. To achieve the best sleep, keeping a regular sleep schedule can provide the consistency that internal clocks can begin to rely on. Hormones are cyclical and very responsive to daily repetition, so going to sleep and waking up at the same times every day can directly have a positive effect on hormone balance. If you have problems sleeping, please address them. Mastering consistent quality sleep is one of the single best things you can do for your overall health besides exercising.
Excellent nutrition – Nutrient deficiencies are one of the fastest ways to wreck one’s health, including creating imbalanced hormones. However, the other side of that coin is that having a whole food, low sugar, low chemical diet can be a fast path to fantastic health. Many hormones are sensitive to chemical additives (such as colorings and preservatives) in foods and drinks. Removing artificial sweeteners, dyes, and preservatives from your diet can be the opportunity your hormones have been waiting for. Likewise, banning sugary items can allow the body to pay attention to healing rather than expend energy on maintaining blood sugar levels. Lastly, reducing intake that causes inflammation, such as alcohol, foods fried in vegetable oil, fast foods, and refined flours, can greatly reduce the burden on the body and allow for hormones to readjust.
Reduce Stress – Stress is underrated as a hormone-wrecker, and just because it is a constant in our society does not mean it should be tolerated in unhealthy levels. There is a very high “return on investment” for spending time identifying key drivers of stress and reducing them until your blood pressure, sleep, anxiety, and hormone levels return to normal. Asking for help, delegating chores, or simply using the word “no” more often can relieve psychological pressure and physically reduce the stress hormone called cortisol. Toxic levels of stress may be one of the key causes of more severe symptoms related to menopause.
Stepping It Up: Potent Supplements - If you’ve mastered the basics but are still suffering from hormone imbalances such as low estrogen, nutritional supplements are superb for addressing the situation. Many traditional herbal remedies that have been around for centuries are now understood better by researchers and backed up by scientific studies. The most researched plant substances that are worth a try are adaptogens and plant phytoestrogens.
Adaptogens are a class of plant substances that can help a body adapt to stressors, reducing the after-effects of a stressful event. Adaptogens can act as a normalizing influence on hormone levels. For example, if the hormone estrogen is under-producing, an adaptogen such as maca can bring levels up by helping the action of the pituitary and hypothalamus on all endocrine glands, including the ovaries, which produce estrogen (9). If a hormone such as cortisol (the stress hormone produced by the adrenal glands) is over-producing, adaptogens tend to bring the level down (10). This is in addition to reducing many menopause symptoms, including hot flashes and poor sleep (9).
Plant phytoestrogens are estrogen-like substances created by a plant, that fit into human estrogen receptors around the body and have estrogen-like effects on humans. One particularly powerful plant phytoestrogen comes from rhapontic rhubarb. The active substance, rhaponticin, can stimulate estrogen receptors. In a 2-year study, researchers found that ERr 731, an isolate from the rhubarb plant Rheum Rhaponticum, was able to greatly reduce menopause symptoms of depression, hot flashes, anxiety, and dry vaginal tissues (11). This potent substance obtained these positive effects without causing overstimulation or abnormal growths in the uterus’s linings. However, it does not help maintain bone density.
The Great Equalizer: Hormone Replacement Therapy (HRT)
The theory behind hormone replacement is to increase the supply of hormones that have been brought low by age-associated decline or to correct an imbalance that causes negative symptoms. Hormones that are subject to age-related decline (and generate many symptoms when out of balance) are estrogen, testosterone, progesterone, and possibly adrenal hormones such as dehydroepiandrosterone (DHEA) and cortisol.
Testing can help determine the balance of hormones, identify which hormones need to be supplemented, and to what dosage level. Hormone tests may be done through blood, saliva, or urine samples. Once the correct hormones are identified, the doctor or healthcare practitioner can help determine the most effective form to take, such as injections, tablets, creams, gels, or lotions. Sometimes, more than one hormone has to be taken to correct imbalances. Retesting may be necessary to determine that the appropriate blood levels have been achieved, and it is important to report back to the doctor any reduction of symptoms.
Who’s a Good Candidate for HRT?
Imbalanced or low hormones may completely resolve if the basics of health (see above) are addressed, making the use of hormones unnecessary. However, for those still experiencing symptoms even after mastering the basics, HRT can be a game-changer. Still, there are some risks (see below), so the ideal candidate (12, 14):
Has multiple, severe symptoms of menopause
Would like to maintain bone density beyond menopause
Would like to prevent dementia if at high genetic risk
Suffers from early-onset menopause or is estrogen deficient
Does not have the genetic tendency to form blood clots (Factor V Leiden genetic mutation, for example)
Has no history of estrogen-based cancer, such as breast cancer
Has a healthy liver
Has no history of deep vein thrombosis (DVT) and/or pulmonary embolism
Has never had a heart attack or stroke
Not meeting all the qualifications listed above doesn’t automatically contraindicate receiving HRT, but there should be a thorough discussion with your doctor if you do not.
Benefits of HRT:
Numerous studies show that HRT can improve many of the “quality of life” markers (15, 16) and even reduce some chronic heart issues and mortality if HRT is begun soon after the onset of menopause in otherwise healthy women (15). The health benefits can be profound, especially the ripple effects from having better sleep and being able to have sexual relations without pain. HRT often:
Helps regulate temperature / prevent hot flashes
May prevent diseases of the blood vessels and heart
Rectifies thinning and drying of the vaginal tissues (VVA)
Reduces risks of osteoporosis and dementia
Risks of HRT:
One particular study showed HRT had significant health risks; however, when the data from the study was later sorted by age categories, it reduced health risks while still showing a great benefit for many (16). Some studies show an increase in venous thromboembolism (VTE, a blood clot in a vein) and stroke when using HRT (12). Other studies have shown increased risks for breast cancer and heart disease (13). Risks can vary by the patient’s health history and age, the particular hormones given, the method of delivery of the hormones, and the family history of diseases (13).
HRT risks can be reduced by (13):
Using minimal amounts of targeted, bioidentical hormones
Continuing to work on the 5 pillars of health (sleep, exercise, nutrition, stress, social support/relationships)
Getting regular check-ups and engaging help if symptoms change or new symptoms appear
The doctors and healthcare professionals at TCIM encourage women to end “silent suffering” by starting a conversation with us. We are well-placed to help you address even the toughest symptoms of menopause. The only requirements are to be willing to come in for an evaluation, take some tests, and try the most up-to-date, potent, and reliable therapies available. Please, trade a moment of frank conversation for lasting comfort. Together we can create a customized treatment plan to alleviate menopause symptoms.
Jonathan Vellinga, MD is an Internal Medicine practitioner with a broad interest in medicine. He graduated Summa cum laude from Weber State University in Clinical Laboratory Sciences and completed his medical degree from the Medical College of Wisconsin.
Upon graduation from medical school, he completed his Internal Medicine residency at the University of Michigan. Dr. Vellinga is board-certified with the American Board of Internal Medicine and a member of the Institute for Functional Medicine.
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