A Naturopathic Guide to Menopause

· What is menopause?

· Why are they important?

· What are naturopathic treatments for menopausal symptoms?

· Link to complimentary consult here

What is Menopause?

Menopause is defined as a state of transition from reproductive to post-reproductive years, notably determined by the absence of menstruation for one year. Natural menopause can occur around the age of 45 years old, with the median age in women in the United States being 52.54 years old. This progression of significant hormonal changes result in the body no longer being able to ovulate and menstruate. There are instances of premature or medically induced menopause, such as in a total hysterectomy. All forms and timings of menopause are to be evaluated and treated with care to support an ease of transition and to ensure improved health outcomes overall. Typically, symptoms do accompany this hormonal transition, yet each person’s experience is their own. Some may have obvious symptoms, some may be going through the transition without any significant effects to their day to day lives.

We classically know of the symptoms associated with menopause as:

hot flashes
changes in menstrual cycle patterns
vaginal pain and dryness
trouble sleeping
cognitive decline
weight gain and/or difficulty losing weight,
shifts in one’s mood,
fatigue
hair, skin and nail changes
and many other symptoms.

80% of women experience hot flashes, and up to half of those women can experience these for multiple years. These can all begin in the 2-8 year period before menopause called perimenopause, as estrogen and progesterone production by the ovaries begin to decline.

There is more to consider besides the symptoms experienced during menopause. It has been shown that women going through menopause are also more susceptible to diabetes, cardiovascular disease and osteoporosis. This doesn’t necessarily mean this is an inevitable shift in one’s health, but it is more so an opportunity to prioritize one’s health in order to avoid the predisposition to these negative affects to one’s health. The menopausal transition can be seen as a time to prioritize your health. We will review some ways the naturopathic approach is a valuable asset in your care through a hormonal and life transition.

What are the potential causes of Menopause?

Normal aging is the number one cause of menopause. There are other ways menopause can be prematurely induced, such as due to a total hysterectomy including the ovaries, ablation can stop the menses but typically the ovaries can still produce hormones, chemotherapy can create early menopause. An autoimmune condition known as Premature Ovarian Failure can also cause early menopause. The hormonal shift is rather interwoven with other systems of the body- the adrenal system, thyroid, nervous system, musculoskeletal systems, amongst others- as these receive signaling from hormones released by the ovaries- estrogen, progesterone, and testosterone. There are other tissues in the body that produce these hormones as well, such as muscle and adrenal tissue, but the amount significantly decreases in the menopausal transition. So it would be helpful to support these systems as well, as they are experiencing a shift too. As is the naturopathic approach, we want to support all systems of the body and work to address what components of lifestyle and health history can be supported for a graceful transition.

Getting a Comprehensive Evaluation of Menopause

There is a reasonable amount of certainty in evaluating and diagnosing menopause, and that’s usually because it is apparent when a period hasn’t happened for a year. Otherwise, there are types of lab testing to use to confirm menopause

Follicular Stimulating Hormone (FSH): This is used for testing ovarian response- its release is sent to the ovaries to stimulate the growth of eggs. When FSH is >25, this could indicate the ovaries are no longer responding to this signal, and suggesting menopause.
Anti Mullerian Hormone (AMH): This can accurately predict the timing of the final menstrual period within the following 2 years. Usually tested in conjunction with FSH.

Common Prescription Treatment for Menopause

Common prescriptions for treating menopausal symptoms are going to be with synthetic or bioidentical hormones, and this is usually to bring relief of hot flashes and other symptoms. The decision to treat with hormone therapy requires some consideration of age, where the benefits of therapy exceed the risks when one is before 60 years old, if there is a history of breast cancer, estrogen or progestin-dependent cancer, history of stroke or venous thrombosis, liver disease, untreated hypertension, then it is advised to not utilize hormone therapy as it may increase risks in all these avenues.

Physiological data and clinical outcomes demonstrate that bioidentical hormones are associated with lower risks, including the risk of breast cancer and cardiovascular disease, and are more efficacious than their synthetic and animal-derived counterparts.

Holtorf K. The bioidentical hormone debate: are bioidentical hormones (estradiol, estriol, and progesterone) safer or more efficacious than commonly used synthetic versions in hormone replacement therapy? Postgrad Med. 2009 Jan;121(1):73-85. doi: 10.3810/pgm.2009.01.1949. PMID: 19179815.

Premarin, (conjugated equine estrogen) a synthetic estrogen, may be an easy form to dose on hormone replacement. However there is data showing increased risk of stroke, triglycerides, inflammatory markers, reduced libido, pancreatitis, and increased growth of uterine size. Yes, this may reduce hot flashes, but these risks are not to be taken lightly. Bioidentical hormone therapy is a favorable alternate, as it has proven to be accompanied by fewer consequences as synthetic hormones. Your naturopath can help here if this is an option you seek. Remember, since menopause is not a condition, we are not acting to eliminate entirely, but want to reduce your menopausal symptoms to make the transition easier.

Naturopathic Treatments for Menopausal Symptoms

Fortunately, not all is lost if one is not a good candidate for hormonal therapy. Your naturopath is well attuned to what can be effective in reducing menopausal symptoms, and will work from a patient-centered approach to provide care with better health outcomes and reduced negative consequences. It is not uncommon for women to utilize complementary therapies in addressing menopausal symptoms. Your naturopathic physician will help you find what is the best fit your you. Please note that this article is for your information and is not considered medical advice. Please ask your health care provider if any of these treatments are right for you.

Any good treatment will take your individual health state into account, and testing for your current hormones levels can help precisely direct treatment into the areas where it's needed most. Blood hormone testing at a minimum should be completed, however blood testing of hormones doesn't give the whole picture. Saliva hormone testing can incorporate testing adrenal function as well as multiple types of estrogen, as well as progesterone, testosterone and DHEA levels. Saliva hormone testing also reveals free hormone levels, which directly correlate to the amounts of hormones that the tissues can use, or are "bioavailable". Blood testing unfortunately includes hormone levels that are bound to carrier proteins and not available to tissue for use.

Perimenopausal symptoms are associated with estrogen and progesterone declining, but many are also associated with low cortisol levels and adrenal dysfunction too!

A full assessment of adrenal function through testing saliva cortisol levels at least 4 times in a 24 hour period gives the most complete picture of adrenal function. Many times we have had patients come to us requesting hormones for their perimenopausal insomnia, increased anxiety, fatigue and inability to lose weight. These symptoms are associated with estrogen and progesterone declining, but they are also associated with low cortisol levels and adrenal dysfunction too! How can we know if the culprit is estrogen, progesterone or cortisol without testing first? If we don't have to replace hormones, and only need to treat adrenal dysfunction to get relief, we can also eliminate the potential risks associated with synthetic and bio-identical hormone replacement and still achieve relief.

You can read more about natural menopause treatment in another article Embracing Change.

General Recommendations to Support the Transition into Menopause:

Dietary Recommendations

A plant based diet has been shown to improve hot flashes as well as reduce risks of chronic disease processes associated with menopause. The Mediterranean diet is a good example of a diet that prioritizes whole plants as well as fish, dairy, and eggs
Cut out: processed and refined foods, spicy foods, alcohol- this shows to increase menopausal symptoms. Also avoid any trigger foods, such as your food intolerances
Include: soluble fiber: 1-2 tablespoons of ground flax seed can reduce hot flashes
Include: Foods rich in magnesium and calcium- dark leafy greens, avocados, coconuts, nuts
Include: Organic soy- Either soy protein or soy isoflavone daily has been shown to reduce symptoms of hot flashes, improvement in bone health, reduced weakness, palpitations, improved mood
Include: Omega-3 fatty acids- these provide an improvement to cognitive health, cardiovascular health, reduces LDL cholesterol and triglycerides, and improves dry-eye syndrome

Lifestyle Recommendations

Stress reduction- this is a lifelong, ever-changing endeavor. But it truly is the fulcrum of which your health depends on. Managing our stress can help maintain a balance in cortisol (the stress hormone), blood sugar, and inflammation Here’s a few ways to reduce the impact of stress on the body.
Mindfulness-based stress reduction
Exercise – especially muscle building exercises. This is a classic anti-depressant, improves bone health, cardiovascular health, reduces dementia risk and breast cancer risk. This would involve spending 30 minutes 3-5 days a week doing moderate-intensity aerobic exercise and 15-20 min of anaerobic exercises.
Yoga, walking, stretching
Prioritizing sleep · Support your adrenals · Focus on supporting your mental health

Herbal Remedies

Black cohosh
Maca
Red clover
Evening primrose oil
Hops
Ashwagandha
St. John’s Wort (not if you are on antidepressants)
Licorice (not if you have high blood pressure)

Hydrotherapy

This overall supportive type of therapy can be best used in conjunction with other therapies. Be sure to read more about hydrotherapy! In regards to hot flashes, the application of hot and cold water to the body can help regulate the thermoregulatory center of the brain, that is greatly influenced by the presence of estrogen. In-office treatments can support this process as well as support the nervous system and digestive systems. If there is not time for an appointment, doing a hot and cold contrast shower can provide some benefit!

These are some examples of how we can provide individualized care to your concerns. You may work with our team of providers at PCNM if you choose to have a multi-faceted approach to your health.

References:

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