A season of change is upon us as Autumn draws near. Each year at this time I am reminded of the path of peri-menopause into menopause. As I reflect on my own journey I realize that this time changed the course of my life. Peri-menopause was filled not only with physical changes but also remnants of unresolved issues and the gateway to evaluate how I was living my life, what I wanted and the changes I was willing to make. The path into and through menopause can truly be a gift.
The menopausal transition spans 3-9 years, typically starting around age 45 with a range of age 44-56. The transition is dynamic, beginning with longer cycles, periods that are lighter and shorter or heavier and longer in length. During early peri-menopause progesterone levels begin to fall, estrogen typically remains the same or increases. When progesterone declines and estrogen remains the same, an imbalance is created. The first symptoms experienced are irregular periods and often excessive vaginal bleeding. This is often a time of weight gain, premenstrual headaches, bloating, mood swings and forgetfulness. As a woman moves closer to menopause, defined by 12 months without a period, estrogen declines and hot flashes often occur. A hot flash is a sudden sensation of warmth that can become intense heat over the face, scalp and chest area. This is often followed by feeling chilled. The journey of peri-menopause and accompanying symptoms is our adaptation to hormonal changes and it is temporary. Hormonal changes often occur at a time in our life where other changes happen such as children leaving home, career changes and aging parents which can result in increased stress, difficult choices and challenges. It is also a time when we have the opportunity to think about our own self care, how we want to create the second half of our life and opportunities to express our creativity. I see this transition and all of its storms as a passage into the stage of life of wisdom. Each of us has lived many years and it is our time to pass on what we have learned to younger women and men.
The physical health of each woman affects her menopausal experience. There is an interaction of all the hormone producing organs. The adrenal glands secrete hormones that help us cope with the many stresses of life. If peri-menopause is entered after years of stress or a chronic illness, then adrenal fatigue accompanies a normal, natural process of hormone imbalance often causing more severe symptoms. Cortisol, which is secreted by the adrenal glands during times of stress can produce undesirable effects if elevated for too long. These include weight gain, spiking blood sugar levels, loss of bone density, vulnerability to yeast, allergies, etc. Thyroid problems are intricately connected to menopause. Estrogen dominance will often trigger Hashimoto’s and many women exhibit hypothyroidism. Missing meals, craving sweets or poor nutrition affects digestion, can result in leaky gut, dysbiosis, which leads to inflammation and can affect the immune system, adrenal glands and brain. As you can see the body is interconnected and balance is key for optimal function. During the menopausal transition, the body speaks loudly and becomes our guide as we seek support, health and well being.
The beginning of the change is an opportune time to see your physician for a complete physical, labs and conversation about your unique symptoms, medical history, lifestyle and current stressors. This is also an important time to assess your cardiovascular risk, vitamin D level and osteoporosis risk.
I imagine that your first concern is to decrease symptoms that are affecting your current life. During early peri-menopause irregular bleeding and heavy bleeding are often issues. I have found Maca (Lepidium Peruvianum) to be helpful in stabilizing menses. Lepidium peruvianum is an adaptogen that works to balance the hypothalamic pituitary ovarian and adrenal axis. It may also help to restore balance with other symptoms such as irritability, depression, hot flushes and fatigue. Soy and flaxseeds have been found to improve cognitive function, reduce vaginal dryness and improve bone mineral density. Licorice, dong quai and wild yam help to balance hormones. I have found Sibiric Rhubarb to be the most effect herb in decreasing hot flashes. Kava is helpful in reducing anxiety. I recommend combination products to reduce depression, which often contain 5HTP, St. John’s Wort and SAMe, plus Black Cohosh.
Supplements to improve cognition include fish oil, Huperzine A, Ginkgo Biloba, phosphatidylserine and Acetyl-L-Carnitine. I have often treated fatigue with adaptogens such as Rhodiola, Maca, Glycyrrhiza, Ginseng and Ashwaganda. Some herbs to improve sex drive include Damiana, Ashwaganda and Maca.
Sleep is a common issue during the menopausal transition. I work with sleep using herbs such as Kava, Valerian root, Hops, California poppy and Passionflower. Sometimes I suggest 5-HTP, melatonin, and if a woman is on hormone therapy, taking her progesterone right before bed. I will also utilize hypnotherapy and Emotional Transformation Therapy to facilitate entering into the sleep state.
DHEA, the precursor to sex hormones, gradually decreases with age. Supplementing with DHEA can be helpful for women to increase vitality, improve the stress response and for some improve sex drive. A recent study demonstrated that local DHEA applied to the vagina improved sexual functioning in postmenopausal women.
What about bio-identical hormones? Are they safe? Bio-identical hormones are identical to your hormones. They are FDA approved for moderate to severe vasomotor symptoms (hot flashes, night sweats). What is currently known from recent studies suggest that estrogen and progesterone are safe for women close to the menopausal transition. If a woman has a uterus, she must take progesterone with her estrogen. It is recommended that estrogen be given in a transdermal form. There is a risk for venous thromboembolic events with oral estrogen. Transdermal estrogens come in the form of patches, creams, gels and sprays. There are two ways that bio-identical estrogens are made, one is a synthetic made by pharmaceutical companies the other is compounded. The primary difference is that there are preservatives and fillers in the pharmaceuticals plus specific dosages. Compounded bio-identical hormones can be individually dosed for the woman and has no preservatives or fillers. There are local estrogens that can be used vaginally for vaginal dryness and to protect against vaginal atrophy. I typically use estriol suppositories or creams for local treatment, which has little systemic effect. It is important to discuss your medical and family history with your physician prior to starting hormone therapy to evaluate your risks and benefits.
The foundation of our health is how we take care of ourselves. Our internal structure is our bones.
Bone health includes regular physical activity, 1200mg of calcium and adequate vitamin D. Generally, you can get 500mg of calcium in your diet. Other dietary recommendations include a whole foods diet high in vegetables and fruit, legumes, especially soy, and whole grains. Increase your intake of cold water fish, salmon, halibut, mackerel. Reduce refined foods, alcohol, sugar and salt.
Menopause like the autumn time is a transition, a time of letting go of what no longer serves us and walking through the gateway to a new time, a time to step into our power, our wisdom. We all go through this transition, let us walk together.
