Redefining Approaches to Menopause - What to Expect and What Options Are Available for Management

Most women spend their entire lives waiting for their menstrual cycle to end. “No more discomfort!” we cry, thinking that this glorious time will bring cessation of all our hormone imbalances, headaches, skin concerns, bloating, mood swings, and of course risk of pregnancy. But as the time passes and new symptoms start to show, the concern can now become: “Am I going through the change, or is this something else?” This concern is exceptionally valid, as the symptoms of pending menopause can extend far beyond the typical night sweats and hot flashes.

So, how is menopause defined? The traditional sense of the word “menopause” indicates the end of the fertile window, the time when menstrual cycles stop and estrogen levels decline. This can begin as early as 40 years old and extend into the 60s for some women, the best indicator being the age at which her mother went into menopause, but of course lifestyle factors can greatly influence this age. Every woman is trained to be in tune with her body, and the slightest change can have us up all night wondering what’s going on. A woman concerned about premenopause will notice a steadily declining estrogen on bloodwork, and perhaps no other symptoms. Education is the most important goal for any health-care practitioner working with a premenopausal woman. Gathering information about age of mother’s menopause, family history of estrogen-sensitive cancers, and stress-management tools are imperative to a well-rounded health-care approach. A woman is considered perimenopausal when she begins to experience symptoms such as hot flashes and night sweats. Some women will notice their menstrual cycles come more often and then suddenly spread out for a couple months. At times, flow can become heavier or alternate between spotting and heaviness.

Bloodwork is the most objective way of determining menopause. When levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) begin to rise, paired with a steady decline in estrogen levels, a diagnosis is made.^[1] Many women never experience hot flashes or night sweats but go through a transition made of other symptoms. The most common discreet signs of menopause include memory loss, foggy thinking, vaginal dryness, mood fluctuations, depression, anxiety, and insomnia. Hair and skin go through their own changes, often becoming drier and more brittle. The decline in estrogen can increase the rate of bone loss, making a woman more susceptible to osteoporosis and easy fractures.

Management of Menopause

The management and health goals for menopause will vary depending where a woman is with her estrogen levels. The premenopause phase is the ideal place to begin to address family history and have tools in place to balance hormones. The more work that is done to clean up diet and establish regular exercise, sleep, and digestion during this phase, the better prepared she will be when menopausal symptoms kick in. That being said, many women with healthy lifestyles still experience significant symptoms, and women with less healthy patterns experience none. Genetics is to blame for at least part of this, but the more we can do to control our lifestyle factors, the better we will be overall. Often, a visit to a naturopathic doctor doesn’t become imperative until a woman is fully immersed in menopause and experiencing symptoms that are affecting her everyday life. At this point, the hormone fluctuations can create a complicated mess of symptoms that involve estrogen, progesterone, thyroid hormone, and our stress hormone, cortisol. Management requires some detective work to find out where to begin and which hormone pathway to influence. Numerous charts have been created to simplify this, as well as a range of urine and blood tests that can help discover how hormones are being metabolized. One of my favourite tests is the DUTCH (Dried Urine Test for Comprehensive Hormones) hormone test by Precision Analytical, because it provides a flowchart that simplifies the results for practitioners and patients alike. Based on these results, a wide range of herbs, vitamins, micronutrients, and antioxidants can be used to shift hormone patterns and provide relief in the short and long term.

It is important to remember that menopause is a healthy and natural transition, and that the goal of treatment is never to reverse the process. In fact, the risks of having elevated hormone levels for prolonged periods of time can lead to dangerous consequences. The conventional medical system has provided patients with the option of hormone replacement therapy (HRT), which provides lower levels of estrogen and progesterone to maintain blood levels. Certain family lines with higher risks of estrogen-sensitive cancers should not delve into this approach, as the risks far outweigh the benefits.^[2] However, replacing hormone levels can prove beneficial to those with significant symptoms impacting their daily life. Bioidentical hormone replacement therapy (BHRT) has come into play in the last few years as a natural source of hormones provided by naturopathic doctors through the use of topical creams. Regardless of the method chosen, every patient receiving hormone therapy should be monitored for elevated hormone levels; liver enzymes; and new symptoms such as bleeding, cramping, and abnormal discharge.

So, if I Would Like to Avoid the Hormone Replacement Route, What Are My Options?

As mentioned above, the first place to start is always with diet and digestion. These are the foundations of health, and without the proper digestion and absorption of nutrients, we cannot make any impact on hormones. Normalizing digestion includes identifying and eliminating sources of bloating, gas, and heartburn, while regulating complete bowel movements. This includes determining food sensitivities, either through the use of food-sensitivity testing or following an anti-inflammatory elimination diet specific to the patient. In my experience, the elimination of gluten, alcohol, caffeine, and red meat has had a profound effect on reducing the frequency and intensity of hot flashes, allowing most women to have a more restful sleep. However, this diet change is not an easy undertaking, and it requires support in terms of recipes and meal-planning ideas.

We know that what we put into our bodies determines how well our bodies can function, but what we eliminate from our bodies is equally important in maintaining good health. Hormones are fat-soluble molecules, which means they like to get stored in fatty tissue. They are also very easily reabsorbed within the body. This means that if digestion is sluggish and someone tends towards constipation, the excess hormones that would normally be excreted can get reabsorbed into the blood and build up in the circulation. Exercise is the most potent antidepressant, anti-inflammatory, anticancer, and antiobesity medication out there. The ability to burn fat tissue releases stored hormones, and when you pair that with a regular bowel habit, elimination of unnecessary hormones can be successful. Sweating is also an effective way to eliminate through the skin, but if you are one of those people who have a hard time breaking a sweat, ask your health-care practitioner if sauna treatments would be indicated for you. Many herbs are used to balance hormones and prevent the rapid fluctuations that cause hot flashes. Some of the more common herbs include black cohosh and wild yam. However, these herbs are not indicated for everyone and should still be used cautiously. Below is my list of go-to herbs and supports for menopausal symptoms:

• Licorice is known to support the adrenal glands and the production of cortisol. Since cortisol plays a large role in determining levels of progesterone in the body, managing the adrenals and their production of hormones can reduce menopausal symptoms.
• Dong quai is a herb commonly used in traditional Chinese medicine to balance blood, regulate the menstrual cycle, and support the reproductive organs. It is most commonly used in combination with other herbs and has shown success in reducing the intensity of hot flashes.^[3]
• Maca root powder is a herb with affinity for the endocrine system and mucus-producing glands. It has been used traditionally in South America for menstrual irregularities, hormone imbalance, and most commonly for vaginal dryness. However, it often doesn’t show its effectiveness until at least one month of regular use.^[4]
• Red clover is also used in combination with other hormone-balancing herbs. This specific herb contains two plant-based estrogens called genistein and daidzein, which are also found in soy products.^[5] Caution must be used in women with a family history of estrogen-sensitive cancers.
• St. John’s wort often gets a bad reputation because of its effects on liver enzymes and its ability to alter the metabolism of other drugs. For those who are not taking any medication, this herb can prove extremely efficient and effective in managing depression, anxiety, and insomnia during menopause. I find it best used in combination with other mood-balancing and adrenal-support herbs such as rhodiola, and both can be found in liquid or tablet form.

Beyond this list, there are many more options for herbal and nutritional aids in managing all hormone imbalances. The beauty of naturopathic medicine is the ability to individualize a treatment plan and determine a herbal protocol specific to each person’s genetics, lifestyle, and symptoms. Menopause often gets touted as being a dreaded transition because of the discomfort many women experience. With the right support and management, it can hopefully become a time many women can move through with ease.