TOPIC · HEALTH · MENOPAUSE · EVERYTHING YOU NEED TO KNOW
Every week I am posting about everything you need to know about hormones. This weeks topic is about menopause.
Did you know – Menopause
- The idea that the menopause was a disease was first introduced in 1710
- Early prescribed ‘treatments’ were Leeches to the genitalia and cervix – (OMG),
- Menopausal women were previously described as sour, egotistical, ugly half-forms with coarse features, moustaches, rough voices and flat chests.
- Doctors previously identified menopause through questionable symptoms like Hysteria, Nymphomania, Alcoholism, Kleptomania
- And it wasn’t unheard of for those going through the menopause to be sent to asylums
- Menopause treatments during the 1800s and early 1900s varied from gruesome to downright dangerous and included:
– Mustard hip-baths
– Frictions to stimulate bruising
– Electric therapy
– Opium
– Cold water directed to the abdomen
– The intake of filtered juice of guinea pigs’ ovaries
– A vaginal plug and iced injections on its removal
– Arsenic
– Thyroid gland extract
– Golf
– Orgasm
- In 1966, Dr Robert Wilson published his bestseller, Feminine Forever, calling menopausal women ‘castrates’ and ‘galloping catastrophes’. He recommended oestrogen to make them ‘much more pleasant to live with…not dull and unattractive’.
- A 1980s survey of approximately 8,000 women aged 45-55 found that the vast majority did not report more symptoms or poorer health at reaching menopause.
- A study of 15,000 women found that Japanese women had lower rates of almost every menopause symptom, possibly due to a diet high in soy.
- World Menopause Day is the 18th October
- It’s estimated that there are around 13 million women who are currently peri or menopausal in the UK, ie. 1 third of the entire UK female population.
- Menopause is complete when menstruation is absent for 12 consecutive months
- Usually begins between the ages of 45 and 55, but can develop before or after this age range.
- The median age for menopause is 51
- Black and Latina women may have an earlier menopause.
- About 1 % of women reach menopause before the age of 40, this is called premature menopause or primary ovarian insufficiency.
- About 5 % of women reach menopause between the ages of 40 and 45, this is referred to as early menopause.
- Menopause can cause uncomfortable symptoms, such as hot flashes and weight gain.
- Severity of symptoms varies from woman to woman
- Many don’t need medical treatment
- Many do
- There is no one way to transition, there are as many ways as there are women
- With that said most women develop symptoms about 4 years before their last period which then continue for about 4 years after.
- Some women experience symptoms for a decade before menopause
- Some women experience symptoms for 12 years following menopause.
- What works for your girlfriend will not necessarily work for you
- So STOP taking advice from your girlfriend, your mother, your sister, etc and go to a professional
- An article in The Times Oct 17th – Thousands of women forced to go private for HRT, as they are being denied hormone replacement therapy by GPs.
- There are 3 phases of menopause – peri, pause and post and I will walk you through each phase.
Meet Sally and get to know all about menopause
Intro
Three phases of menopause
Pro's & Con's of HRT
The Future without Estrogen
Estrogen & Breast Cancer
Diagnosing menopause
There are many ways to diagnose menopause, the absence of menstruation for 12 months being the most conclusive.
Evaluation is more important if you are under 47 and your menstruation is absent or you have suffering with several menopausal symptoms – see article on menopausal symptoms
Blood testing
The following blood test can be done by your doctor to indicate if you’re in menopause or there is another cause
- FSH – message from the brain to the ovaries
- LH – message from the brain to the ovaries
- AMH – evaluation of the number of eggs
- Estradiol
- Testosterone
- Progesterone
- TSH – thyroid function can affect the menstrual cycle
- Prolactin – if high the menstrual cycle may be impaired
Symptoms
Symptoms are an excellent, though not necessarily conclusive way of evaluating menopause
- Regularity of cycle
- Bleeds or no bleeds
Additional tests
The following tests give a bigger a picture of menopause and general health which may be affected by menopause, some of which your doctor can help with others are private testing
- Urine testing – DUTCH complete
- Blood testing
- Thyroid function tests
- Blood lipid profile – ask your doctor
- Inflammation tests, such as CRP, ESR, s.Ferritin – ask your doctor
- Liver function tests, such as ALT, AST, GGT – ask your doctor
- Fasting Insulin & Blood sugar – ask your doctor. Or fasting insulin can be tested here
- Functional lipid and glucose profile.
The 3 Phases of Menopause
- Peri – the turbulent years before
- Menopause – bleeding has been absent for 12 months
- Post – the golden years after
Peri-menopause
- Transition period before menopause
- The time when hormone production begin to decline
- Can be a very turbulent time
- Estrogen begins its gradual decline around late 30’s early 40’s
- Progesterone is more unstable – some cycles you produce it other cycles you don’t
- Testosterone is usually unaffected until mid-40’s
- Menstrual cycles become irregular, sometime shorter, sometimes longer
- Bleeds may become heavier or may be lighter
- The bleed may be late or even skipped then regular again
- These menstruation symptoms can last anywhere from a few Some women have no perimenopause symptoms and enter menopause suddenly
- Other symptoms that appear are also unique and individual, there can be many or there can be few – see the article on peri-menopause & post-menopause symptoms
Menopause
- Really just the end of the transition period – menstruation has been absent for 12 months
- You’re done and dusted
Post-menopause
- The golden years
- Your second spring as the Chinese say
- Time to learn to live with 70% less Estrogen
- The classic menopause symptoms should subside and eventually stop, may continue for an average of 4 to 5 years.
- Replaced with new symptoms of aging – many of which are the result of low levels of Estrogen – see article The Future You without Estrogen and the article on peri-menopause & post-menopause symptoms.
Peri-menopause & Post-menopause Symptoms & Complications
Important for you to understand
- Some of the symptoms are due to the turbulence of hormonal imbalance and stop with menopause.
- Unfortunately most of the symptoms are due to low levels of Estrogen which do not disappear after menopause
- Symptoms can be more severe if menopause occurs suddenly, such as with a surgical removal of the ovaries
NB! – Every woman’s experience is unique
Symptoms
- less frequent / irregular cycles and menstruation
- heavy bleeds – flooding
- lighter bleeds
- vasomotor symptoms
- hot flashes
- night sweats
- flushing
- insomnia
- vaginal dryness
- weight gain
- mood swings
- depression
- anxiety
- difficulty concentrating
- memory problems
- reduced passion for pretty much everything that used to be important
- reduced libido, or sex drive
- dry skin, mouth, and eyes
- increased urination
- sore or tender breasts
- headaches
- racing heart
- urinary tract infections (UTIs)
- reduced muscle mass
- painful or stiff joints
- reduced bone mass
- less full breasts
- hair thinning or loss
- increased hair growth on other areas of the body, such as the face, neck, chest, and upper back.
Menopause – Whys
- The natural – age related decline in ovarian function, on average age 51 ovarian production of Estrogen and Progesterone ceases
- Surgical menopause – removal of the ovaries will create instantaneous Removal of the uterus alone does not create menopause
- Chemotherapy – treatments for cancer can halt menopause, though it may not be permanent
- Radiotherapy – treatments for cancer only affects ovarian function if radiation is directed at the ovaries.
- Smoking – can lead to early menopause
- Primary ovarian insufficiency – about 1% of women experience menopause before age 40 (premature menopause). Due to failure of the ovaries to produce normal levels of Estrogen, which can stem from:
-genetics
-autoimmune disease
-often no cause can be found.
Menopause Symptoms – What to do?
2 phases require 2 solutions
Phase 1
Lessen the symptoms during peri-menopausal turbulence
Phase 2
Maintain Estrogen’s positive effects on aging ie. slow aging
The Number 1 treatment for both is
- Hormone Replacement Therapy / HRT – both Estrogen and Progesterone for phase 1
- Estrogen Replacement Therapy / ERT for phase 2
HRT Reduces / removes symptoms such as
- hot flashes
- night sweats
- flushing
- vaginal atrophy
- osteoporosis
- brain fog
- mood swings
- heavy bleeds
ERT Increases / maintains
- bone, muscle, skin strength
- vaginal health
- heart health
- brain health
- colon health
- blood sugar control
- weight management
- gut health
Possible Medical Treatments for Specific Menopausal Symptoms
- Hair thinning / loss – topical minoxidil 5%, used once daily
- Hair loss – antidandruff shampoos, commonly ketoconazole 2% and zinc pyrithione 1%
- Unwanted hair growth (witch hairs) – eflornithine hydrochloride topical cream
- Hot Flushes, Anxiety & Depression – SSRI’s – selective serotonin reuptake inhibitor
- Vaginal dryness – non-hormonal vaginal moisturizers and lubricants
- Vaginal dryness – low-dose estrogen-based vaginal lubricants in the form of a cream, ring, or tablet, such Vagifem, Ovestin
- Vaginal dryness & painful intercourse – ospemifene a SERM – selective estrogen receptor modulator
- Recurrent UtI’s / bladder infections – prophylactic antibiotics
- Insomnia – sleep medications SEE MY BLOG ON SLEEP
- Osteoporosis – denosumab, teriparatide, raloxifene, or calcitonin.
The Pro’s & Cons of HRT
The Con’s (for some women)
- For some an increased risk of breast cancer
- For some an increased risk for blood clots
- For some an increased risk for uterine cancer.
All the above are dependent upon/affected by several factors, such as:
- the type of Estrogen
- the form of Estrogen
- the amount of Estrogen
- how it gets into the body
- if combined with a Progestin or not
- your general level of health
- your life style choices, such as smoking and or alcohol intake
- your weight
- your family disease history, such as breast cancer / uterine cancer in the family
The Pro’s (for all women)
- Reduction in peri-menopausal / menopausal symptoms
- Increased libido
- Increased mental and emotional energy
- More happy and passionate about life
- Stronger, glowing, moist skin
- Better gut health
- Less tummy fat
- Less brain fog
- Decreased risk for osteoporosis
- Decreased risk for colon cancer
- Decreased risk for bladder and vaginal infections
- Decreased risk for vaginal dryness
- Decreased risk for Type 2 Diabetes
- Decreased risk for dementia and Alzheimer’s
- Decreased risk for heart problems
But the decision is yours.
For more info READ MY ARTICLE – CONSIDERING HRT
Menopause Lifestyle
If your symptoms are mild you may not feel the need for using HRT and the following may help, but remember HRT is also good for slow aging
Keep cool and stay comfortable
- Dress loose
- Layered clothing
- Keep the bedroom cool
- Avoiding heavy blankets
- With regular night sweats, consider using a waterproof sheet under your bedding to protect your mattress
- Carry a portable fan for if you feel flushed
- Avoid spicy foods
Weight Management
- Reduce carb intake – max 30g per meal –
- TRE – time restricted eating – 8 – 10 hours eating window
- H:I:T exercise 20 to 30 minutes a day.
Communicating your needs
- Talk to a professional about any feelings of depression, anxiety, sadness, isolation, insomnia, and identity changes.
- Inform family members, loved ones, or friends about your emotional state.
De-stress
- Relaxation and breathing techniques, such as:
- Yoga
- Box breathing
- Meditation
Taking care of your skin
- Use oils to reduce skin dryness
- Oil cleansing in the evenings
- Avoid excessive washing, bathing or swimming
Manage Sleep Issues
Quit Smoking
- Nothing good to say about smoking
- Avoid exposure to second-hand smoke.
- Exposure to cigarettes can increase symptoms.
- Exposure to cigarettes can increase risk for breast cancer
Limit Alcohol
- Heavy drinking increases symptoms
- Heavy drinking increases your risk of breast cancer.
Support Liver function
- See the article on Estrogen & Breast Cancer further down in the blog.
The Future You without Estrogen
Estrogen is responsible for optimal function of many of the tissues and organs of the body.
Loosing 70% of its production during menopause has enormous consequences for physical, mental and emotional health
Aging becomes more attractive and functional when ‘some’ Estrogen is replaced
Replacing the 70% is not the goal – that you age more gracefully, with strength and passion is
Symptoms of low Estrogen
- Vulvovaginal atrophy – your vagina shrinks, dries and becomes weak resulting in
– painful intercourse
– increased risk of infections
– stress incontinence
– weak pelvic floor
- Mood and emotional changes, such as reduced passion
– Low libido
– Decreased need to be sociable
- Slower metabolic rate and insulin problems resulting in
– increased risk for type 2 diabetes
– weight gain
– tummy fat
- Osteoporosis
– weaker bones with reduced mass and strength
· Sarcopenia
– muscle loss with reduced muscle strength
- Sagging, drying skin due to the loss of collagen and hyaluronic acid
– wrinkles
- Drying joints due to loss of hyaluronic acid
– joint pain
– restricted movement
- Memory challenges
– increased risk for dementia and or Alzheimer’s
- Eye problems such as
– Cataracts
– Glaucoma
– Dry eye syndrome
- Periodontal disease
– bone loss in the jaw
– increased risk for teeth falling out
- Heart and or blood vessel disease
– blood vessels become stiffer
– LDL cholesterol increases
– HDL cholesterol deceases
– Insulin resistance increases
– Blood pressure increases.
Estrogen and Breast Cancer
Estrogen has 2 roles
1. Creating DNA damage / mutations that initiate a cancer process
– NB! There are MANY other molecules that create DNA damage initiating cancer
2. Feeding’ breast, uterine, ovary, and testicle cancers, promoting proliferation / growth of the cancer cells.
– NB! Focus from the medical world is to starve the body of Estrogen thereby decreasing the ‘food supply’
Focus on preventing DNA damage
- Increase / support detoxification processes in the liver, breast and other tissues.
- The so called phase 1, 2 & 3 detoxification pathways
Phase 1
- Metabolises fat soluble molecules, like Estrogen to oxidated molecules ie. free radicals, some of which can create DNA damage / mutations which create cancer cells
- Phase 1 is controlled by genetics, but can be ‘manipulated’ via specific supplements.
- Get to know your phase 1 preferences
Phase 2
- The oxidated molecules are ‘conjugated’ packed in nutrients to make them water soluble ready for excretion via stool and or urine
- Phase 2 uses various enzymes all of which can supported by specific nutrients
- Get to know your phase 2 preferences
Phase 3
- The conjugated molecules excreted through the stools land in the gut on their way to excretion. Some of these can be unpacked and reabsorbed.
- Phase 3 is dependent upon the amount of b-Glucuronidase enzyme produced by gut bacteria where high levels will increase reabsorption and vice versa
- Get to know your production of b-Glucuronidase
Focus on decreasing the ‘food supply’ aka Estrogen
- Decrease intake of xeno-estrogens, such as
-Plant hormones
-Plastics – PBA’s etc
-Parabens in creams
-Dyes in clothes and other fabrics
-Etc
- Increase excretion of all Estrogens by supporting the detoxifications processes – see above.
Good supplements can include
Good foods
- Liver
- Eggs
- Sulphur containing foods.
Post-Menopause Hormone Triad
These 3 hormones create most of the symptoms related to post-menopause aging. Control these hormones and aging becomes graceful and slower
- Estrogen
- Cortisol
- Insulin
Increase Estrogen
- Replace and support through ERT
Decrease Insulin
- Blood sugar control through
– diet
– sleep
– exercise
– controlling Cortisol levels
– use a continuous glucose monitor to track your blood sugar
Decrease Cortisol
· Decrease energy needs aka stress
– follow Cortisol’s 24 hour cycle as much as possible
– 6am – 6pm activity & food
– 6pm – 6 am rest & fasting
- Reduce inflammation
– Eat anti-inflammatory foods like organ meats
– Reduce raw veggies as they are proinflammatory
– Reduce / exclude all omega 6 foods and oils such as seeds, grains and pulses
– Increase omega 3 oils and foods such as oily fish and fish oils
– Optimize gut health
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