First — let’s talk about what menopause is NOT!

Menopause is NOT a disease or illness or a “condition”.

Menopause is NOT a terrible process for many — perhaps most — women. Many women have few problems and while some women do experience a number of difficult symptoms, the good news is that we are constantly learning about natural, gentler ways to minimize and cope with those symptoms.

Menopause is NOT something to be feared! In many cultures, menopause is welcomed as a transition to “elder” or “wise woman” status.

Menopause will NOT make you fat — excess calories and not enough physical activity do that — but, menopause can make it easier to lose track of calories and not feel like being physically active.

Menopause does NOT always destroy your desire for sex — it may require some changes in both partners, but the desire is still there.

When does menopause begin?

Menopause is defined as the end of menstrual periods and fertility and technically begins one year after your last period.

Generally speaking, menopause can begin in your forties and fifties.

It’s a normal and a natural transition phase from one of fertility and the potential for pregnancy to one where you no longer have a monthly cycle and won’t get pregnant.

The peri-menopausal phase (“peri” means around — so peri-menopause means “around menopause”) is highly variable and can begin in your thirties or forties and can be recognized by increasingly irregular periods and possibly some symptoms such as hot flashes, sleep disturbances, changes in your skin tone and vaginal changes such as dryness and discomfort during sexual activity.

During menopause, the main reproductive hormones estrogen and progesterone begin to fluctuate, sometimes rapidly. It is this rapid change in hormone levels that appears to cause the symptoms associated with menopause — but it is also the change in the ratio in the levels of hormones that appears to be at the root of these symptoms.

The symptoms of menopause and peri-menopause will vary from one woman to the next. And this transition can be relatively easy or it can be difficult.

Some women do experience a more difficult transition, but the good news is that many of the symptoms of menopause can be relieved by natural approaches like Bioidentical Hormone Therapy, herbs and lifestyle adjustments.

There are two main medical theories about menopause — they could be described as the hormone-deficient theory of menopause and the hormone-toxicity model — the concept that the high levels of hormones in pre-menopausal women are essential for successful reproduction, but can be harmful as a woman ages.

Medical theories about menopause

Hormone-deficiency model

The idea behind this theory is that menopause is a hormone-deficient state and the levels of hormones during the fertile years are normal. This is the approach that many mainstream physicians have — that menopause is a disease of aging where the levels of the female reproductive hormones are too low, and must be “remedied” often by the use of synthetic hormones.

Hormone-toxicity model

The second theory is that the fertile years involve an excess of hormones that are biologically necessary for reproduction but that at continued high levels, these same hormones can be detrimental. Menopause is nature’s attempt to limit a woman’s exposure to these high levels in those reproductive years.

Evolutionary theories about menopause

There are a number of theories about why human women go through menopause — what is the biological “point” of transitioning from a fertile phase where one can bear children to an infertile phase where natural pregnancy is not possible?

Here are some possible ideas based on evolution about why menopause occurs:

• Because human babies need extended care and labour and delivery carries some risks, going through menopause prevents pregnancy and the risks of pregnancy and delivery and allows women a better chance to raise the children they already have.
• Females are born with their ovaries already fully supplied with eggs. Men, in contrast, continually produce sperm. As a woman ages, her ovaries and the eggs within also age, increasing the chance of non-viable or damaged eggs. The idea is that menopause at around the age of 50 was an evolutionary adaptation that prevented the use of these damaged eggs.

Mainly, menopause appears to be nature’s “compromise” or an evolutionary adaptation for a woman’s health and well-being.

For successful pregnancies to occur, the reproductive hormones estrogen and progesterone have to cycle through high levels. These high levels can prove to be detrimental over time for some women. Menopause lowers the levels of these hormones and these lower levels are overall safer for women in their later years.

Also, humans are one of the few creatures on earth that nurture and care for their young for prolonged periods of time. And the thinking is that menopause limits the number of children women would bear and take care of — and also allow women to survive longer to take care of the children that they have.

As mentioned, in the medical fields, for many years, menopause has been thought of as a “hormone deficiency state.” So, if you are “hormone deficient”, first of all, that defines an abnormal condition or a disease state — and second of all, that means that all medicine had to do was replace those hormones!

The alternative way of thinking about menopause is that the pre-menopausal state with the high levels of reproductive hormones is necessary for fertility, but when the need for a longer life overtakes the need to reproduce, those hormone levels should drop to those levels which are safer — or as some would say, less toxic.

 

Symptoms of menopause

Some of the most common symptoms of menopause include:

• Irregular periods
• Hot flushes (aka power surges), night sweats
• Sleep problems (insomnia, restless sleep)
• Mood problems (mood swings, irritability, depression, nervousness)
• Changes in sex drive
• Vaginal dryness, itching
• Fuzzy thinking, forgetfulness, fatigue
• Weight gain
• Hair loss or increased unwanted hair
• Gastric problems such as bloating, indigestion and acid reflux
• Urinary problems — urine leakage when you sneeze or cough (stress incontinence)
• Breast tenderness
• Joint and muscle stiffness or pain
• The uniqueness of each of us and our response to the menopause transition

It is important to realize that each woman is unique in every respect and this means that some women will experience these signs and symptoms to varying degrees.

Some will only experience the irregular periods and be primarily frustrated because they never will know when a period is on its way!

Others will experience a range of these “signals” and may have only mild or moderate discomfort. Other women will truly have a difficult time with one or more symptoms.

The symptoms may come and go. Sometimes being the primary concern and, at other times, those same symptoms may become of less concern.

And not all the symptoms are directly a result of the hormone variations for all women. For example, most people find that too little sleep makes all the other concerns seem that much worse. If you are getting too little sleep AND experiencing mood swings, well, who wouldn’t get a bit cranky or irritable!

Phases of menopause

Menopause is the natural and normal transition from fertility to non-fertility. And it is accompanied by changes in the levels of those hormones that permit menstruation, fertilization, implantation of a fertile egg and pregnancy.

Menopause can be divided into two phases:

Early menopause (also known as peri-menopause the “peri” means “around” menopause) when periods start to become irregular in timing and in flow. Some women begin to have some signs and symptoms at this point. For other women, the only sign is irregular periods.

Late menopause: Some women will notice more irregularity and signs and symptoms. A woman is technically in menopause one year after her last period.

If you do not want to get pregnant, remember to keep using your birth control of choice especially in the early phase of menopause, at least for a year.

Also note that if you are using hormonal birth control, this may “mask” the main sign of menopause, the irregular periods, and may also make decisions about potential treatments a bit more complicated.

Early menopause

In general, most women show signs of peri-menopause, or the pre-menopausal phase starting around the age of 50.

Early or premature menopause (before the age of 40) can occur for a number of reasons including surgical or chemical removal of the ovaries, family history, chromosomal abnormalities and illnesses such as cancer and some autoimmune diseases.

Estrogen and progesterone are well balanced

This is the way menopause, we think, was designed by nature — that the levels of estrogen and progesterone balance each other out.

When these hormones are reasonably well balanced (along with testosterone) most women will experience relatively few symptoms. These are the women who may have a hot flash from time to time, some rough nights, some mood changes and occasionally other symptoms, but they are all pretty mild. Yay!

Too much estrogen as compared to progesterone

This type of menopause is often called “estrogen dominant” but it could just a easily be called “progesterone deficient”. I mean, is the glass half empty or half full? It often depends on your perspective, doesn’t it?

It may not even be the absolute amount of estrogen in your system that is the critical factor — it may be the ratio of estrogen and progesterone that is most important.

The most common symptoms associated with estrogen dominance

Symptoms typically associated with estrogen dominancein menopause are listed below — you’ll notice that these are associated in general with menopause — the difference is in degree and how it affects your life:

• Irregular or otherwise abnormal menstrual periods
• Water retention –this may be in the ankles, wrists, face or abdomen
• Breast swelling and tenderness and fibrocystic breasts
• Pre-menstrual headaches
• Mood swings, irritability and depression, lack of concentration or memory loss
• Trouble getting to sleep or staying asleep
• Decreased interest in sex
• Thyroid problems (cold hands/feet, fatigue, changes in skin)
• Hair loss
• PMS

In early menopause, estrogen dominance has been linked to breast and uterine cancer, allergies and autoimmune disorders, ovarian cysts, blood clotting problems that may be related to an increase in heart disease.

So, can anything natural be done to deal with an estrogen-dominant type of menopause?

Well, yes — since it’s the ratio of estrogen and progesterone that seems to be most critical, if you use topical progesterone, you can re-balance that ratio!

Studies using progesterone in menopause

Progesterone can be used as a cream to relieve hot flashes and night sweats.

Studies have shown progesterone treatment to significantly reduce the frequency and the severity of hot flashes and night sweats, especially if the treatment is started early in the menopause transition.

Side effects reported included swelling of the breasts, anxiety, headache and nausea. When progesterone is used as a cream, the most common side effects reported include skin rash or reddening, itching and other skin reactions along with the other reported side effects.

Natural progesterone has been used intra-vaginally to protect the endometrium (the lining of the uterus) and to control irregular bleeding in menopause while avoiding any side effects.

Risks that may be associated with progesterone

Women using natural progesterone have reported very few side effects or risks.

For the most part, the adverse effects reported were very similar to those reported for no treatment or for placebo treatment. It is also important to keep in mind that research is continuing in the best uses of progesterone and other reproductive hormones.

Also, many of the reports — especially in the “popular press” and on the internet don’t distinguish between synthetic estrogens and progestins and the natural (bioidentical) hormone, and they don’t often make a distinction between estrogen treatments and combined estrogen-progesterone treatments. This problem even exists in the scientific literature. The terms are often confused and it is not always clear what the researchers were actually studying!

Finally, most of the research that has been done — and, most of the risks that have been identified — come from studying the effects of synthetic estrogens and progestins, NOT from studies using bioidentical estrogen and progesterone. There are and can be many differences. For example, we don’t see the bloating and abnormal growth of hair (hirsutism) with the natural forms of progesterone, while we do with the synthetic progestins.

Natural progesterone also may be protective for some types of breast cancer, as compared to the synthetic progestins.

But, the fact remains that there is a lot we do not know about natural progesterone treatment for menopause and you should be aware of the potential risks.

To avoid these risks, if you or someone in your family has a history of breast cancer, heart or blood clotting problems, stroke, uterine fibroids, etc., work with a skilled clinician who has experience with these hormones and monitor levels of hormones and any side effects.

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Be well!