Menopause! What you should know.

Menopause! What you should know.

Menopause can be a challenging transition for many women, typically occurring between the ages of 48 and 52. This period often includes symptoms such as hot flashes, extreme mood swings, insomnia, hair loss, uncontrollable weight gain, skin changes, vaginal dryness, decreased sex drive, and concerns about osteoporosis, breast cancer, and heart disease.

Despite these difficulties, menopause is a normal part of life, marking the transition from the reproductive phase to a highly productive and meaningful stage. During this time, the fear of pregnancy no longer limits sexual activity, children are independent, and women can pursue interests outside the home without overwhelming family obligations. This phase offers an opportunity for women to focus on personal development rather than child development.

However, for many, this transition is accompanied by significant physical and emotional challenges. Why is this normal transition so difficult for many women? Hormonal imbalances, often exacerbated by the typical Western diet (high in fat and carbohydrates, low in fibre), a stressful lifestyle, and environmental factors, contribute to these challenges. Women in other countries, who do not share these habits, often experience fewer menopausal symptoms.

In this article, we will critically examine menopause, distinguishing fact from fiction to understand the role hormones play in producing menopausal symptoms.

Menopause occurs when a woman permanently stops ovulating, marking the end of her reproductive years. It is diagnosed when a woman has not had a menstrual cycle for a year and exhibits elevated levels of FSH (follicle-stimulating hormone). Elevated FSH indicates the cessation of ovulation but does not reflect the body’s estrogen levels.

Most conventional doctors use the FSH test to diagnose menopause. However, this test only confirms that ovulation has stopped and does not measure estrogen levels. Estrogen is produced from various sources, with the ovaries being just one contributor. Hormones produced by the adrenal glands can be converted into estrogen in fat and other tissues.

Additionally, estrogen can be obtained from dietary sources such as soy and flaxseed. Our environment also exposes us to numerous chemicals that act like potent estrogens. Given the multiple sources of estrogen available both within the body and from external sources, it seems unlikely that estrogen deficiency is the main issue during menopause.

Salivary testing, which provides a more accurate measure of estrogen levels, often reveals that most menopausal women have normal or even elevated estrogen levels in their tissues. Blood tests typically show low estrogen levels during menopause because the estrogen is produced in the tissues and not transported from the ovaries through the bloodstream.

A deficiency in progesterone can explain many of the symptoms experienced during menopause. Hot flashes, for instance, are a response to the withdrawal of both estrogen and progesterone. As women stop ovulating after menopause, progesterone levels drop. However, estrogen levels do not decrease proportionally due to exposure from other sources outside the ovaries. Restoring balance by adding progesterone can safely relieve these symptoms. While adding more estrogen may help with hot flashes, it exacerbates the imbalance and can lead to side effects such as bleeding, weight gain, stroke, and an increased risk of breast cancer.

Mood swings during menopause can also be traced to a deficiency in progesterone or an excess of estrogen. Progesterone has a calming, sedative effect on the brain by attaching to GABA receptors, which decrease anxiety and elevate mood. These receptors are the same ones targeted by antidepressants and anti-anxiety drugs. Therefore, menopausal women on antidepressants may benefit from the mood-stabilizing effects of progesterone, potentially reducing their need for these medications.

Insomnia is another frequent complaint among menopausal women, likely due to the lack of progesterone’s calming effects. Reintroducing progesterone can usually improve sleep quality.

Many women also experience poor concentration and memory lapses during menopause. Progesterone plays a role in insulating nerve cells with myelin, which is essential for efficient nerve impulse conduction. Reduced progesterone levels can disrupt myelin production, leading to cognitive issues.

An imbalance between estrogen and progesterone can interfere with thyroid hormone function, which is crucial for metabolizing food and converting it into energy. Improper thyroid function can result in weight gain, fatigue, food cravings, and low blood sugar symptoms.

Other troubling symptoms include the loss of scalp hair and the growth of facial hair post-menopause. Testosterone, produced by the ovaries and adrenal glands after menopause, is used by the body to balance estrogen in the absence of progesterone. This can lead to male-pattern baldness and facial hair growth. Reintroducing progesterone often reverses these effects, promoting scalp hair growth and reducing facial hair.

Understanding the critical role of progesterone in maintaining hormonal balance can help address many menopausal symptoms naturally and effectively.

Do I Need Estrogen?

Menopause cannot be solely attributed to estrogen deficiency. While some women may experience symptoms related to low estrogen, the key to minimizing menopausal symptoms is maintaining a balance between estrogen and progesterone.

For women that are overweight, it is well-documented that this excess weight contributes to excess estrogen production. Estrogen is stored in fat cells, so overweight women often have higher levels of this hormone, increasing their risk of diseases such as uterine and breast cancer, which are more common in overweight individuals.

Estrogen can also contribute to weight gain and make it difficult to lose weight. Women who are overweight should not take standard estrogen replacement therapy unless a saliva test indicates a hormonal imbalance.

Women who are not at risk for estrogen deficiency should generally avoid estrogen replacement. Estrogen therapy is typically approved for two indications: relief from hot flashes and prevention of osteoporosis in women at high risk. However, we believe that no woman should take estrogen without first undergoing salivary testing. Weight-bearing exercises can decrease the risk of osteoporosis more effectively than estrogen.

If a woman is experiencing hot flashes, restoring hormonal balance with progesterone can alleviate these symptoms, especially if saliva testing indicates a progesterone deficiency. Additionally, using weaker estrogens, such as estriol or plant-based estrogens found in soy, can help by moderating the effects of stronger estrogens.

Not all women are at high risk for osteoporosis. Women of North European descent, those with a sedentary lifestyle, history of smoking, or long-term steroid use are more at risk. Women not in these high-risk groups typically do not need estrogen to maintain normal bone health.

People of colour generally have a very low risk of osteoporosis and should not take estrogen for this purpose. However, very thin individuals of any race may be at risk and should be evaluated on a case-by-case basis.

Embracing a holistic approach that includes salivary testing, lifestyle changes, and natural alternatives can help women manage menopause symptoms more effectively and safely.

Saliva Testing

Saliva testing is the most accurate method to determine levels of steroid hormones such as progesterone, estrogen, DHEA, cortisol, and testosterone. It surpasses blood tests in accuracy and usefulness when evaluating the need for hormone replacement.

Steroid hormones are fat-soluble, meaning they dissolve in fat or oil rather than water. Since oil and water don’t mix, the body produces carrier proteins that dissolve in water and attach to fat-soluble hormones. This allows the hormones to travel through the watery bloodstream to their target tissues.

However, steroid hormones attached to carrier proteins in the blood are inactive and unable to enter cells because of the water-soluble carrier proteins surrounding them. Blood tests measure the total amount of hormone, but more than 99% of it is bound to carrier proteins and inactive. This doesn’t reflect the levels of active, unbound hormones available to the body, which is what salivary testing measures. Salivary testing reveals the amount of active hormone, helping to determine symptoms of perimenopause and menopause.

Several factors affect the amount of active estrogen in the body, such as increased weight, insulin levels, stress, low fibre, and high-fat diets, all of which can increase unbound estrogen. This can lead to symptoms of estrogen excess, even if the total estrogen levels in the blood are normal. Conversely, exercise, high-fibre diets, healthy fats, reducing stress, and avoiding external estrogens can decrease active estrogen levels.

Without salivary testing, it’s impossible to determine active hormone levels due to these numerous variables. Salivary testing can measure active levels of estrogen, progesterone, DHEA, testosterone, and cortisol, all of which can be altered by menopause.

Hormone replacement therapy (HRT) is often prescribed without utilizing accurate testing to confirm the need for such therapy. Millions of women have been placed on HRT despite its significant short- and long-term side effects. Better and safer results can be achieved by using saliva testing and working with a functional medicine practitioner to customize hormone replacement.

Low Estrogen or Low Progesterone

FSH levels are commonly used by doctors to diagnose menopause, as FSH elevates when ovulation or egg production ceases. The hormone directly dependent on ovulation is progesterone. While estrogen can be produced from various sources within the body and externally, progesterone is only produced after ovulation.

Estrogen and progesterone are produced together throughout the reproductive years, functioning best when in balance. Estrogen replenishes the uterine lining lost during the menstrual cycle, while progesterone further develops the uterine lining and breast tissue in preparation for potential pregnancy. These hormones also impact the brain, endocrine system, immune system, and more. When balanced, they do not cause symptoms.

During and after menopause, ovulation ceases, stopping progesterone production. Unlike estrogen, progesterone cannot be made from other hormones and is not significantly available in the environment. During menopause, women may have normal or elevated tissue levels of estrogen but low or immeasurable levels of progesterone. This hormonal imbalance is more likely to cause menopausal symptoms than an estrogen deficiency alone.

Importance of Progesterone

Progesterone does more than balance estrogen; it is crucial for the normal function of several organ systems. Its functions include using fat for energy, decreasing water retention, reducing depression and anxiety, improving mental function, increasing sex drive, and enhancing the effectiveness of other hormones like thyroid hormone, testosterone, and estrogen.

Understanding and addressing progesterone deficiency through accurate saliva testing and natural balancing can significantly alleviate menopausal symptoms and improve overall well-being.