Menopause
A few months ago one of my long time patients (we will refer to her as “Susan” to conceal her real identity) called our clinic and expressed that she needed to schedule an appointment immediately. It sounded like she had an urgent health issue. When she arrived later that afternoon she explained her predicament:
“Dr. Monster, I think that I am in menopause. My body has been taken over by an alien and I want it back. I managed to raise four kids while working 50 hours a week. I have run marathons. I was even the president of the PTA at one point, but I am no match for this menopause. I feel like I can heat the entire house with my hot flashes. My husband is being unreasonable. He says that we cannot sleep naked without blankets with the windows open in 40 degree weather. In the not too distant past, sleeping naked might have led to something more than sleep, but there is no way I am letting that man anywhere near the Sahara Desert. And as much as I am enjoying having martinis and red velvet cupcakes for dinner, I know that I am missing a couple of important food groups. I just can’t recall what those groups are. My memory seems to have left with my periods. In fact, I have forgotten where I keep my memo pads. However, I do remember where my bladder leakage pads are kept because I do not dare leave the house without those. And where did my waist go? Should I be reporting it missing? I think it might be hiding under my drooping breasts, but I’m not certain of that. On a positive note, I’m no longer crying during Hallmark commercials. My tear ducts have taken on a life of their own and are non discriminating. Do you think that you can help me? I’m feeling a little desperate. If you can’t help me, my husband and children have threatened to lock me up in a padded room and right now that sounds pretty good.”
I assured Susan that I could help her. I would also like to reassure you that most women do not experience a menopause like Susan’s. In fact, many of us are fortunate to breeze through menopause without a single symptom and are ecstatic to find out that there are actually 30 days in a month rather than 25. Menopause can be one of the most vibrant times in your life.
To better understand menopause, we need to get our vocabulary straight. Menopause occurs when your menses has stopped for one year (excluding other reasons for not having a menses such as pregnancy and breastfeeding). In the United States, the average age of menopause is 51, meaning many of you will stop having a menstrual period around age 50. However, a “normal” menopause can occur anytime between 35 and 55. The term “perimenopause” defines the time of transition into menopause when hormone levels start to drop. This can start happening 10-15 years prior to menopause.
Speaking of hormones, the major players in the game are estrogen, progesterone and testosterone. To better understand what happens at menopause, it is important to understand the role that each of these hormones play in your body prior to menopause.
Estrogen is the star of the show. Estrogen tends to build everything up. When you are having your period, estrogen builds up the lining of the uterus. It keeps skin plump and bones strong. It keeps the vagina lubricated. We are learning that it also likely plays an important role in brain health. Estrogen is the hormone most associated with femininity.
Progesterone plays an important supporting role. It balances estrogen and is largely responsible for the timing and consistency or the menstrual cycle. Progesterone also helps you get quality sleep.
Testosterone is more of a minor player for women. Women typically have low levels of testosterone. Testosterone increases libido and helps build muscle mass.
During perimenopause hormone levels begin to drop. Progesterone is generally the first one to drop. This often happens around age forty. When this happens you may experience increased PMS, anxiety changes in your menstrual cycle and insomnia.
Estrogen tends to drop closer to menopause. Some of the symptoms associated with a drop in estrogen include hot flashes, vaginal dryness, and changes in memory, thinning skin, incontinence, lower sex drive and more insomnia. Lower libido and loss of muscle tone are at least partly due to lower testosterone levels. There are also changes you can’t see like thinning bones and increasing cholesterol levels.
Some unlucky women like Susan, seem to experience all of the negative symptoms. Others get through menopause relatively unscathed and enthusiastically embrace the transition.
At NaturoMedica, we treat women going through the menopausal process every single day. No two treatment plans are exactly alike. In terms of intervention, the level can vary from diet and lifestyle changes, to vitamins and herbal formulas, to conventional hormones and medications.
Diet and Lifestyle:
During the menopausal transition, a healthy diet becomes more important. Sugar is enemy #1. Exercise is your new best friend. Did I mention to exercise, exercise and exercise?!?!? Your adrenal glands (which handle your stress hormones) are being taxed. Acupuncture can be a particularly effective treatment to help manage stress and improve sleep quality during these transition years. If you feel like you are not dealing with stress as well as usual, consider getting your adrenal glands tested. At NaturoMedica we offer salivary adrenal testing which is an effective way to test your stress response and to design a treatment plan to help you better cope with stress.
Nutritional Supplements:
There are many vitamins and minerals that can be beneficial around the time of menopause, but some of the most important are:
- Vitamin D
My favorites are Naturologie gel caps and Naturologie liquid vitamin D. Don’t forget to have your vitamin D levels tested via a simple blood test to find out how much vitamin D you should be taking. Vitamin D provides many different benefits including improving mood, helping increase bone mass and supporting the immune system - Calcium/Magnesium
Calcium/magnesium is important to bone health and also helps with sleep and relaxation. Thorne Cal-Mag Citrate Powder is a best seller in our dispensary. For a bone health formula, I like Osteoprime Ultra by Integrative Therapeutics. - B Vitamins
B vitamins are great for boosting energy and may help you better cope with stress. They also help support a healthy menstrual cycle. Vital Nutrients B Complex and BioGenesis Methyl Factors are two great formulas. - Essential Fatty Acids
Omega-3 fatty acids have many anti-inflammatory properties that are shown to be especially beneficial during menopause including having a positive effect on heart disease, hypertension, arthritis and diabetes. Additionally, omega-3’s help balance mood. Two excellent supplements are Xymogen's Pure Omega 900 capsules and Pharmax Finest Fish Oil liquid.
Botanical Medicines:
Botanical medicines have been used to manage menopausal symptoms for hundreds if not thousands of years. Many of them contain compounds which include several different plants . Make sure that you only use botanical medicines under the care of a physician.
Some examples of botanical formulas that we carry in our NaturoMedica dispensary are:
Estrovera by Metagenics-this product contains a special extract of Siberian rhubarb that has been shown in studies to reduce the number of daily hot flashes as well as reduce other menopausal symptoms.
AM/PM Menopause by Integrative Therapeutics- this is a hormone free blend that contains two targeted formulas to address common menopausal symptoms that occur during the day and at night. The AM formula contains black cohosh to help reduce hot flashes and mood swings, along with panax ginseng and green tea extract for increased energy. The nighttime formula also contains black cohosh to help with hot flashes but also contains valerian to help improve sleep.
Femenessence Pro- this product contains the plant maca which has been well studied to balance hormones which helps control overall menopausal symptoms. In clinical studies, the product reduced hot flashes, reduced vaginal dryness, increased energy and helped elevate mood.
Hormone Replacement Therapy
Hormone replacement therapy (HRT) uses the hormones estrogen and progesterone and sometimes testosterone to control menopausal symptoms and aging. These hormones can be prescribed by doctors during perimenopause and/or menopause.
At NaturoMedica, most of the hormones that we prescribe for our patients are “bio-identical”. This means that they are identical to the hormones that are created in our own body rather than made up of synthetic compounds. They come in many different forms including creams, patches, liquids and capsules. Some of them are available at conventional pharmacies and some of them are custom made at compounding pharmacies.
With hormone replacement therapy, most women can get relief from their menopausal symptoms fairly quickly. However, not everyone is a candidate for hormone replacement therapy. We can help walk you through your individual risk assessment taking into account your cardiovascular health and cancer risk to help you determine if you are a good candidate for HRT. There can be a lot of fear and confusion surrounding this topic and we spend a great deal of time educating each of our patients with the most up to date information.
And by the way, Susan, the patient that I referred to at the beginning of the blog ended up choosing bio-identical hormones and I am pleased to report that she is symptom free.
My hope is that you will schedule an appointment to discuss your menopause. No two women are exactly alike. We take great pride in being able to work with you individually to help you come up with a plan to transition into what can be the best time of your life.
