Menopause and Perimenopause

Menopause misconceptions

Menopause is not a disease

Menopause is a natural transition that happens when the ovaries run out of eggs. Symptoms may appear during this transition stage (and there is a lot which can be done to ease symptoms). However, menopause is not a disease that needs to be treated with drugs.

Menopause symptoms are not caused by estrogen deficiency

Broadly, peri-menopause and menopausal symptoms are caused by fluctuations of hormones, and especially a relative deficiency of progesterone to estrogen. It is true that estrogen levels decrease. However, the other female hormone, progesterone, is affected much more.

The Female Cycle and Progesterone, and Estrogen Dominance
menopause and progesterone

A follicle (called the corpus luteum) is left after eggs are released by the ovaries. The corpus luteum is responsible for the great increase in progesterone the second half of a woman's cycle.

When the cycle stops, the ovaries continue to make some estrogen. However, without ovulation, there is no corpus luteum. This causes a significant drop in progesterone (compared to estrogen), and symptoms of progesterone deficiency.

An increased ratio of estrogen to progesterone can be called "estrogen dominance."

 

Common symptoms during peri-menopause

Estrogen dominance and other hormones

Hot flashes are perhaps the most common symptoms women have during peri-menopause. These are caused by fluctuations in hormones which cause blood vessels to dilate.

Other hormones can be affected as well. Estrogen dominance can raise something called Sex Hormone Binding Globulin (SHBG). SHBG is a protein in the blood which binds to sex hormones, making them inactive. An increase in SHBG can make testosterone less active.

As SHBG increases so does Thyroid Binding Globulin (TBG). TBG works like SHBG, except it binds to thyroid hormone, making that inactive. An increase in TBG, can lead to symptoms of hypothyroidism.


Common symptoms during menopause

Menopause begins by definition, 1 year after a woman's last period. By this time, the hormonal fluctuations of peri-menopause have calmed down.

Symptoms include:

Why acne, facial hair and hair loss

LH and FSH (as seen in the above chart) are made by the hypothalamus and pituitary in the brain to tell the ovaries to make estrogen. The less estrogen there is, the more LH and FSH go up. This causes LH and FSH levels to be much higher in menopause, then in a cycling woman.

LH and FSH will increase levels of androgens (male hormones), such as testosterone. This can cause acne, facial hair and hair loss.

 

Estrogen and progesterone replacement

Estrogens

Although some women may become deficient in estrogen this is usually not the case. In fact, high estrogen is much more common.

Some causes of high estrogen include:

If high estrogen is a problem, then why do doctor's prescribe estrogen to treat peri-menopause?

Symptoms of peri-menopause are caused by fluctuating levels of hormones. By giving high levels of estrogen drugs, hormones stay at a steady (although high) level. Without the fluctuations symptoms go away. But the problem has not been fixed. Rather the body has been tricked into not producing certain symptoms. The price for tricking the body in this way is increased risk of more severe diseases later on, such as stroke or breast cancer.

Progesterone

Although estrogen dominance is a very common problem, that doesn't mean simply taking progesterone is always the best answer.

Progesterone resistance

If hormones are elevated too much then the body develops resistance. This means it'll take more and more of the same hormone to have the same effect. This can make balancing the right away of a hormone to take difficult, as over time the same amount can be less effective.

Progesterone and other hormones in various cosmetics

In addition, many women are already unwittingly on progesterone therapy. Many topical cremes, and cosmetics contain progesterone, even if it's not on the label. Consider the following quote from a lab which had been testing cosmetic products for progesterone

Several years ago, we offered anonymous testing of suspect face creams for our clients. We were not surprised to find that 90%-95% of all the submitted creams, lotions, etc. tested positive for progesterone. In addition, we found considerable contaminating estrogens and androgens. Faced with the futility of this testing, it has been discontinued. The patients we tested were likely dosed unwittingly with progesterone (non-bioidentical) contained within creams or shampoos and for long periods of time. Such extra progesterone exposure prejudices accurate baseline results, and not only confuses the body's essential hormonal balance, but also proper therapeutic judgement.

Face creams and shampoos are classified legally as cosmetics, and as such, are not under the close purview of the FDA. Not only can manufacturers add progesterone to their products (up to 4%) but they are not required to list it on their labels. Be highly suspect of any product touted as "anti-wrinkle," "anti-aging," "rejuvenating" or "our own special formula." [http://www.diagnostechs.com/Literature/dti_Chrono_9.pdf]

What about progesterone drugs

Medical prescriptions for progesterone, are typically not really progesterone. Rather they are progestins. Progestins (such as Provera - medroxyprogesterone acetate) are drugs that looks like progesterone, but it's not. In fact, progestins produce many side effects which are the opposite of what the real progesterone does.

Doctors often use the words "progestin" and "progesterone" as if they are the same thing, but they are not.

Adverse effects of progestins (which do not occur with natural progesterone) include:

Restoring balance and Self-regulated healing

In certain cases there may be a need to take a form of natural estrogen or progesterone. However, the best way to get healthy, and stay health is by encouraging self regulated healing. This means restoring the body's ability to regulate hormones (and other systems) on it's own.

Factors to consider include:

Basic Nutrition

The Standard American Diet (SAD) is horrendous.

Typical problems in the American diet:

This is just a quick summary. Whole can (and have) been written about the terribly low quality of food most people eat.

Blood Sugar Disorders

High blood sugar which leads to diabetes is very common. When blood sugar goes up, it sets off a cascade with affects the entire endocrine system (and not just insulin). Balancing blood sugar is a must for anyone who wants to rebalance hormones.

There are numerous herbs and supplements which can help.

Digestive disorders

The old adage, "you are what you eat," is only half right.

In truth you are what you eat, absorb, and utilize. If you can't absorb nutrients then it really doesn't matter how healthy the food you are eating is. In addition, taking a dozen supplements to fix other problems won't do anything if your can even digest those pills.

There are numerous signs of poor digestion:

One of the worst things anyone can do for digestion is taking drugs that reduce HCL. This include antacids, proton pump inhibitors (such as the purple pills) and other medications for heartburn.

Although these drugs may have merit over a short period of time in treating H. pylori, they were never meant for long term (chronic) use. It's important to realize that such drugs work by shutting down digestion. The may help in reducing pain, but at a very high price. Remember, if you can't digest your food, you can't get any nutrition regardless of what you eat. And over the long run this can lead to numerous health issues, including hormonal imbalance.

A better approach is to work naturally to restore proper digestive function. This will stop symptoms such as gastric reflux, and improve digestive function.

Stress

Stress can be psychological, physical, or physiological. Any additional demand on the body causes stress. Stress has a dramatic affect on the hormonal system. Specially in terms of menopause/peri-menopause, it shifts steroid hormonal production away from progesterone, and other sex hormones, and towards cortisol.

If stress is caused by toxicity, then it's important to go through a detoxification protocol. If stress is from inflammation, then supplements need to be taken to reduce that. Also, people need reduce the psychological stress in their life. All of this adds up.

Detoxification

There are many ways toxicity contributes to hormonal deregulation. One of the most clear, is the fact that every second of our lives the hormonal system makes hormones, and the liver works to remove them from the body. In this way the body can fine tune exactly how much hormone we have.

However, if the liver can't do it's job well, then hormones build up. Over time this throws off the hormonal system.

Another factor is chemical that mimic hormones which are commonly found in food. These "xeno-estrogens" confuse the body and bind the hormonal system into imbalance. The only way to get rid of these is to work on detoxification and improve the liver's ability to get these things our of the body.

Testing hormones

It may be helpful to test hormones such as estradiol, LH, FSH, testosterone, DHEA, cortisol, and a complete set of thyroid hormones (includes TSH, free and total T3, and free T3).

In some cases, hormone replacement may make sense, but labs should be interpreted with respect towards the total health picture. If there are health problems in any of the other basic categories discussed above, then those issues should be addressed. That is the best way to promote self-regulated healing, instead of merely covering up symptoms with hormone replacement therapy.