Menopause

Menopause – Symptoms and Natural Treatment

Menopause is a normal event marked by the cessation of menstruation for 1 year.  It usually occurs between the ages of 45 and 55.  The transition time leading up to complete termination of menses is called peri-menopause which is characterised by hormonal fluctuation and menstrual changes.  Peri-menopause may last 2-3 years before menstruation stops.

During peri-menopause, as estrogen gradually declines, both Follicle stimulating hormone Luteinizing Hormone (LH) increase due to the lack of feedback inhibition.  LH stimulates ovarian production of androstenedione which is converted into Estrone.  

It is the bursts of LH every 60-90 minutes that are thought to be associated with hot flushes.  Estrone is the dominant estrogen in postmenopausal women and is mainly produced from aromatisation of testosterone in adipose tissue and from androstenedione released from the adrenal glands, as well a small amount from the ovary.

Estrone is about 12 times weaker than ovarian estrogen (estradiol) but is important for preserving bone density and protecting the heart.

Progesterone production becomes erratic in peri-menopause due to ovulation occurring less frequently. Once menopause occurs, progesterone production ceases. Progesterone deficiency causes many of the symptoms of menopause such as mood changes and heavy periods.

Ovarian testosterone production continues after menopause at almost the same rate as menstruating women but is not balanced by estrogen, causing some of the androgenic changes that can occur.

Increasing sex hormone binding globulin (SHBG) can decrease some of these unwanted effects.

Causes of Menopause

• Menopause is a normal event caused by failure of the ovaries to produce estrogen and progesterone.
• Medical or surgical menopause is caused by medical or surgical intervention e.g. removal of the ovaries, radiation, chemotherapy, GnRH antagonists for endometriosis or fibroids, tamoxifen for breast cancer etc.
• Premature menopause: occurs when menstruation stops before age 40: may be caused by surgery, drugs, certain illnesses, auto-immune disease

Risk factors – Menopausal symptoms

Menopause is a normal part of the aging process in all women; however, the following factors may hasten the onset of menopause and menopausal-related symptoms:

• Family history
• Stress and adrenal insufficiency: low DHEA production is associated with menopausal symptoms. In addition, the more cortisol that is being made, the more it is drawing from pregnenolone, leaving nothing left for estrogen (known as the “pregnenolone steal”)
• Poor gut function / bacterial and fungal overgrowth
• Methylation imbalances impairing hormones and detoxification
• Hypothyroidism
• Alcohol and smoking
• Poor diet and nutritional deficiency
• Lack of physical activity
• Low body fat: associated with earlier menopause and increased symptoms
• Obesity

Signs & Symptoms of Menopause

Menopause signs and symptoms vary greatly from woman to woman. When hormone production changes gradually, fewer symptoms are generally experienced.

• Gradual (occasionally sudden) changes in menstrual flow and regularity: cycle length tends to increase
• Hot flushes: occurs in 75% of women – related to spikes in LH
• Insomnia and night sweats: related to hot flushes
• Mood changes
• Vaginal dryness
• Menstrual flooding – due to estrogenic stimulation of endometrium unopposed by progesterone
• Urinary frequency, burning, cystitis and incontinence due to irritation of urethral tissue

TREATMENT STRATEGY FOR MENOPAUSE

• Provide symptomatic relief
• Support estrogen, progesterone and DHEA production
• Increase SHBG (to lower testosterone dominance)
• Support nervous and adrenal function
• Support thyroid function
• Ensure healthy body weight
• Prevent long-term risks (osteoporosis, heart disease)

Dietary considerations

• Ensure whole food, unrefined diet high in complex carbohydrates, adequate proteins and healthy fats
• Increase consumption of phyto-estrogenic foods to support estrogen activity e.g. organic fermented soy, linseeds, alfalfa sprouts (100g tofu and 2 Tbsp ground linseed per day can reduce hot flushes and improve vaginal dryness)
• Increase intake of calcium-rich foods e.g. yoghurt, sardines, green leafy vegetables, tofu, tahini, almonds, legumes
• Increase essential fatty acids: oily fish, linseeds, flaxseed oil, free range eggs
• Ground linseeds daily to increase SHBG
• Fasting is shown to increase SHBG
• Avoid coffee, excessively hot or spicy foods and alcohol: can all increase hot flushes

Supplements that support Menopause

• Vitamin C + bioflavonoids – reduces hot flushes; vitamin C also required to support adrenal glands, an important source of estrogen in post-menopausal women
• Omega-3 & evening primrose oil –  can support hormone production and help relieve menopausal symptoms
• Vitamin E –  can reduce severity of hot flushes
• B-complex –  to support nervous system
• Magnesium –  important for bone health and to support nervous system
• Vitamin D –  enhances estrogen‘s protective effects on bone and may help prevent vaginal atrophy

Herbal considerations

• Estrogen modulators: black cohosh, red clover, chaste tree, dong quai, hops, wild yam
• Ovarian tonics: shatavari, false unicorn root
• Support estrogen detoxification: St Mary‘s thistle, schisandra, turmeric, rosemary

Nervines:

• St John‘s wort – anxiety and depression
  • Lime flowers – anxiety and insomnia
  • Motherwort – anxiety and palpitations
  • Hops – insomnia with night sweats
  • Zizyphus – insomnia with night sweats
  • Chamomile – in combination with dong quai, has been demonstrated to reduce hot flushes and improve sleep
  • Other nervines include passionflower, oats, scullcap
• Adaptogens – withania, Siberian ginseng, Korean ginseng, codonopsis, rhodiola, astragalus
• Adrenal tonics – licorice, rehmannia
• Sweat reduction – sage, astragalus, zizyphus

• Lifestyle / Physical measures
• Regular exercise – helps moderate severity of hot flushes due to effect on steroid hormones. Weight-bearing exercise is also essential to prevent osteoporosis
• Pelvic floor exercises – may reduce incidence of incontinence
• Regular sunlight exposure – to ensure adequate vitamin D
• Stress management – yoga, tai chi, relaxation techniques, massage, meditation
• Wearing light loose-fitting clothing and layers to deal with hot flushes
• Breast self-examination monthly
• Regular bone mineral density check
• Regular pap smears and medical check-up

FUNCTIONAL MEDICINE TREATMENT OF MENOPAUSE

Menopause is a naturally occurring phase in a woman’s life.  Some women breeze through menopause while others have years of symptoms that affect their quality of life.

At our Perth clinic of Advanced Functional Medicine we support women through menopause by bringing various systems of the body back into balance to allow the body to deal with these natural changes more effectively.  We also provide support to the female patients that are experiencing strong symptoms.

Addressing gut health, nutrition, methylation, vitamin and mineral deficiencies, bacterial and fungal overgrowths and hormone production are vital to allow the body to naturally cope through these changes.

If you or a family member are suffering from menopausal symptoms we would love to hear from you.  What age did peri-menopause symptoms begin to start for you?  What remedies have you used that have helped the most?  Please leave a comment below.

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