Menopause is known as the cessation of the menstrual cycle. Menopause actually has three phases: peri-menopause, menopause and post-menopause. Peri-menopause lasts for about 2-8 years before the complete cessation of the menstrual cycle. In many women, this is the time when things start to change. The earliest sign is usually irregular, long or short periods with heavy or light bleeding. Some other well-known menopausal signs can appear in this stage, like hot flashes, insomnia and weight gain. This is because the primary hormone levels are slowly decreasing while becoming more imbalanced. True menopause refers to the complete end of the menstrual cycle for a year in the absence of any other cause. The average age of menopause is 51 years old. In this stage, reproduction capabilities have ceased. Post-menopause is often referred to the time after menopause when the woman’s symptoms are alleviated. There doesn’t seem to be a clear distinction between the three phases. This is likely because there is significant overlap in the symptoms and clinical observations.
Estrogen and Progesterone
There are many hormones in the woman’s body that are related to the changes that take place during menopause. Two of these hormones are estrogen and progesterone. During the menopausal years, the levels of these hormones decline. This affects he structures and organ systems that normally use these hormones for their function. As a woman enters the second half of her life, estrogen and progesterone decrease in her body. It is now known that changing hormone levels are likely just a part of the picture in menopause and not necessarily the cause of the uncomfortable symptoms of menopause. Additionally, other factors like chronic stress, pre-existing conditions and nutrient deficiencies may all impact symptoms and wellness during menopause.
Estrogen is made in the ovaries of the female and the testes of the male. It is also produced in small amounts in other places in the body. Estrogen is almost exclusively recognized for its role in reproduction.
We know that specific cells use estrogen because they have receptors that are used only for estrogen – like a puzzle piece. An estrogen receptor is a binding site, where the estrogen attaches and signals the body to bring about a specific function. Estrogen binding sites are found in the nervous system (brain, nerves), the endocrine system (glands that produce hormones), the skeletal system (bones), the lipid (fat) cells and the cardiovascular system (heart, blood, blood vessels and lymph). These organ systems can be affected by the change of estrogen levels that occur in menopause.
Estrogen plays a role in metabolism. Metabolism is the set of processes that take place to sustain life. It also contributes to the homeostasis required throughout the body. Homeostasis refers to balance and equilibrium of all cells and organ systems. Declining estrogen may be part of the reason fat storage and excess weight gain commonly occurs in the menopausal years. It is easier to gain weight in the middle (stomach) and more difficult to lose the weight due to the metabolic shifts.
Estrogen is also instrumental in glucose (sugar) regulation. As a woman gets older, it is common to see a rise in her fasting glucose levels. In menopause, it is even more important to avoid all foods like sugar and simple carbohydrates. The glucose regulatory system no longer has sufficient estrogen to adapt to high glucose levels. This leads to a higher risk of the development insulin resistance and Type 2 diabetes.
The increase of cardiovascular disease risk in menopause is well established in the literature. It is not known in the scientific world exactly how the risk factor for cardiovascular disease increases. It is hypothesized that the role of the declining hormones coupled with a poor diet and exercise, not enough sleep and chronic stress play a role.
Estrogen is a factor in immune function. Immune cells have estrogen receptors as well. Some women find out that they are less likely to recover from an illness quickly. When the immune system is compromised, it opens the door to the development of diseases, infections and autoimmunity.
Estrogen plays a role in circadian rhythms and sleep. Circadian rhythm refers to the internal cycle of sleep (rest, repair, restoration) and being awake (energy, life) is in balance. The body actually relies on different circadian rhythms in many systems in the body. When this hormone begins to decline, one of the most common complaints women have is sleep issues like insomnia.
Progesterone is essential for fertility and maintaining pregnancy in a woman’s child-bearing years. Its benefits also include breast, brain, nervous system and cardiovascular health. In the brain, progesterone is used for optimal brain function and for healing and repair of the brain in traumatic brain injuries. It is also used as a sleep aid and it eases anxiety.
The long list of symptoms of menopause are not surprising considering the hormones’ effects. The symptoms include hot flashes, fatigue, mood issues like depression and anxiety, incontinence, vaginal dryness, heavy bleeding and insomnia. Hot flashes and night sweats are vasomotor symptoms associated with higher risk of cardiovascular disease.
There are various types of hormone testing that we have available today. We can check hormone levels in the blood, saliva and urine (as metabolites). The blood and saliva tests help clinicians evaluate specific levels of all the different hormones that are present at the time of the test. These two tests are often used in HRT/BHRT.
The urinary metabolites test gives a clear picture of how one hormone relates to another one – if and how imbalance is occurring. This test is also a measurement of how all the various hormones are detoxing out of the body. The practitioner can evaluate the detoxification and balance of one hormone as it relates to another. Some detoxification pathways of estrogen, for example, are considered to be carcinogenic and toxic.
Hormone Replacement Therapy
Hormone replacement therapy (HRT) or bio-identical hormone replacement therapy (BHRT) is customarily the treatment approach for menopause in the naturopathic world. In simple terms, it’s a treatment that assumes that a woman’s declining hormone levels are, in fact, a disorder or deficiency.
I challenge this approach. I consider menopause as a natural process. It’s important for patients and clinicians to consider the implications of exogenous hormone intake – this includes xenoestrogens, synthetic hormones, birth control, bio-identical HRT and even herbal medicines in some cases. This is especially true if a woman has been diagnosed with cancer. If she is already moving estrogen metabolites down a carcinogenic pathway, it would be clearly contraindicated to give her more estrogen.
Proper nutrition from dietary sources initiate balance and healing. Hormone-healthy foods like leafy greens, cruciferous and other vegetables should be a staple in the diet. Foods like flax seeds, sesame seeds and berries have compounds called phytoestrogens which are healthy. These compounds are thought to act as natural hormone modulators in the body. Healthy fats, like olive oil, MCT oil and avocado promote optimal hormone levels, anti-inflammatory benefits and mood balance. An interesting fact is that menopausal symptoms are far less known in the Mediterranean culture. It is hypothesized that their diets which are high in olive oil and vegetables are the reason for this.
Thirty minutes of exercise is especially beneficial in cardiovascular health. It also decreases the risk of osteoporosis, improves immunity, helps with weight management and is useful for restful sleep. Every system listed above that has estrogen and progesterone receptors will be improved with daily exercise. A combination of aerobic exercise, weight training and flexibility training are absolutely crucial in the management of menopause.
All the systems in the body are intricately connected and the stress adaptation system often seems to be central in imbalance and the progression of any disease. It is known that stress does, in fact, exacerbate night sweats and hot flashes. Chronic stress can be alleviated with daily calming practices and meditation.
Proper sleep will help shift poor circadian rhythm balance. All cells have a circadian rhythm that needs to stay in balance for proper growth and repair of the cell. When the sleep-wake cycle is disrupted, this affects the rhythm of the cells.
Botanicals have been used to help with all the unwelcome symptoms associated with menopause. Herbal remedies have a long history of safety and efficacy. Herbal remedies should be recommended by a trained herbalist.
Chaste Tree (v.agnus-castus) has been used for generations to support optimal female hormone health. Black cohosh (Actaea racemosa), valerian root (Valeriana officinalis), peony (Peonia suffruticosa) and motherwort (Leonurus cardiaca) are also great additions.
The most common botanicals for this is black cohosh(Actaea racemosa), sage (Salvia officinalis), red clover (Trifolium pratense), motherwort (Leonurus cardiaca). Valerian (Valeriana officinalis)can be used as well especially if you are also suffering from insomnia.
Depression and Anxiety
Because depression and anxiety are often exacerbated by stress – the herbals that work for both of these issues are often chosen. These include ashwagandha (Withania somnifera), ginseng (Panax ginseng), curcumin (Curcuma longa), motherwort (Leonurus cardiaca) and dong quai (Angelica sinensis).
Valerian (Valeriana officinalis), chamomile (Matricaria chamomilla), passionflower (Passiflora L.), St. John’s wort (Hypericum perforatum) are great botanicals for helping with sleep and stress.
Endocrine Failure or Intelligent Design?
I, as well as hundreds of other clinicians, have studied thousands of articles that have been published in the literature. I am often humbled and amazed at the intricate perfection and design of the body in its healthy state. Menopause is healthy. It is not the beginning of the end. It is a natural transitional stage of every woman’s life. Knowing that, women should be encouraged to arise from the victim mentality of the medical model.
In her textbook, Botanical Medicine for Women’s Health, Dr. Romm speaks about reframing menopause. She writes about the modern, medicalization of menopause and presents the concept of changing our way of thinking in regards to menopause.
“The medical model views menopause as an endocrine disorder that should be medically treated “with the seriousness of other endocrine disorders.” This viewpoint is shared by the natural medicine model as well as the modern medicine one. It seems to define the older woman as one who is in a state of loss, a victim of menopause.
In contrast, the ancient Wise Woman tradition is centred around the nourishment of the whole woman. It defines menopause as a natural event occurring over several years, during which the hormonal and nervous systems undergo profound changes. This view is focused on encouraging the woman to embrace this time of change and live her life with conscious acceptance of the gift of menopause.” Dr. Aviva Romm
You have a choice to reframe your thinking. If you are pre-menopausal, you have a chance to look ahead – not with a heart of fear and dread, but with anticipation of the next amazing mystery of your life. If you are starting menopause, or in the midst of it, embrace the gift you have been given. Nourish your body with nutrition, meditation, sleep and supportive herbals and nutraceuticals. If you need to, reach out to other women who can support you. Take time a for your mental and physical health. Find ways of serving others while taking care of yourselves.