Review of Menopause and Symptoms
Throughout this series so far, we have learned that menopause is a period of time that begins once a woman’s body is done having menstrual cycles. As a woman experiences fluctuating levels of estrogen and other reproductive hormones, she will walk through four distinct stages of menopause:- Premenopause Stage: A woman is still considered fertile but may be experiencing some irregularity in her menstrual cycles as the body begins its hormonal shifts.
- Perimenopause Stage: A more distinctive phase as a woman transitions into menopause. She will typically experience more significant symptoms throughout this phase such as more irregular menstrual cycles, hot flashes, night sweats, mood swings, weight gain, etc.
- Menopause Stage: This stage is diagnosed officially when a woman’s body stops producing estrogen and is not releasing eggs for at least 12 consecutive months.
- Postmenopause Stage: The final stage of menopause is one that every woman will be in for the rest of her life as her reproductive years come to a finish. Symptoms will typically begin to slowly diminish over time.
Understanding Menopausal Hormone Cascades
When most individuals think of reproductive hormones, testosterone and estrogen are the first (and often only) ones that come to mind. Of course, testosterone and estrogen are vitally important hormones for the body to function properly, but several other hormones are affected by menopausal changes as well. Because of this, supplementing with estrogen is not always the best answer for most women.Estrogen supplementation can help to alleviate menopausal symptoms but estrogen may not be the hormone a woman’s body needs as it goes through menopause. Supplementing with hormone therapy like the estrogen-progestin pill significantly increases a woman’s risk of conditions such as stroke, heart disease, breast cancer, and blood clots, as well as increasing inflammatory markers.
Before supplementing with estrogen, it’s important to consider hormone precursors and the role they play in the overall wellness of a woman’s body throughout menopause.
Hormone precursors are essentially hormones that are converted into other hormones. These precursor hormones directly affect the amount of other hormones in the body. Precursor hormones are a vital part of the hormonal cascade that allows the body to function like a well-oiled machine. If the precursors are missing, parts of the machine are missing and everything may not properly work together for optimal health and wellness, and the body will not experience the benefits that other hormones can provide.
Most precursor hormones are produced in the pituitary or adrenal glands.
Pituitary Gland Hormones
The pituitary gland is located in the brain and responds to signals from the hypothalamus, the main control center of your brain. The anterior pituitary gland produces:- Follicle-stimulating hormone (FSH): This helps control a woman’s menstrual cycles and stimulates the growth of eggs in the ovaries. During menopause, FSH increases to help produce more estrogen. These raised levels may cause hot flashes, which many women experience during menopause.
- Luteinizing hormone (LH): This hormone works to trigger the release of an egg from a woman’s ovaries.
Adrenal Gland Hormones
Adrenal glands are small glands that are located above the kidneys. The adrenal glands produce several very important hormones, especially during and after menopause. These include:- Estrogens: Estrogen is composed of estrone, estradiol, and estriol and largely contributes to a woman’s sexual and reproductive function.
- Cortisol: This is a stress hormone that triggers the fight or flight response, as well as helps to manage metabolism, inflammation, and immune response.
- Androstenedione: This hormone is a precursor for testosterone and estrogen that works to increase sexual desire and performance, build muscle, and reduce body fat.
- Testosterone: In combination with estrogen, testosterone helps take care of a woman’s reproductive tissues. It is involved in regulating mood, sex drive, cognitive function, energy levels, skin health, and bone health.
- Pregnenolone: Pregnenolone is known as the “grandparent precursor” for its crucial role as an endocrine precursor and plays an important role in several neurological functions.
- DHEA: DHEA is an important hormone precursor that works to generate hormones such as testosterone and estrogen.
- Progesterone: The main function of progesterone is to prepare a woman’s uterine lining (the endometrium) for a fertilized egg to implant and grow. Upon conception, progesterone is vital to support a healthy pregnancy.
HRT Versus BHRT
What Is HRT?
Hormone replacement therapy (HRT) has been the standard of care for women in menopause with both conventional and integrative physicians. HRT utilizes synthetic hormones in an effort to “top off” a woman’s hormone levels. This can help alleviate many of the common menopause symptoms that women experience.There are two main types of HRT:
- Estrogen therapy (ET): A provider will prescribe a low dose of estrogen, typically in the form of a patch, pill, vaginal ring, cream, spray, or gel. This form is not recommended for women who still have their uterus.
- Estrogen/progestin hormone therapy (EPT): Also known as combination therapy as it combines estrogen and progesterone, this type is best for women who still have their uterus.
Synthetic Versus Bioidentical Hormones
Women who undergo HRT with synthetic hormones are at an increased risk for a variety of complications including:- Endometrial cancer (only in women who are on estrogen therapy who still have a uterus)
- Gallbladder issues and gallstones
- Deep vein thrombosis
- Pulmonary embolism
- Stroke
- Blood clots
What Is BHRT?
Bioidentical hormone replacement therapy (BHRT) was born through the need and patient demand for an alternative to HRT for those looking to avoid synthetic hormones. Bioidentical hormones are made to biochemically mimic the hormones produced in a woman’s body. This means that the endocrine system cannot distinguish them from their own natural hormones.BHRT hormones are formulated using plant-based substances including soy and yam. This made them a more appealing, “natural” form of hormone therapy. However, there are some considerations to be weighed when considering BHRT.
Drawbacks to BHRT
- There are no long-term studies to determine the safety or efficacy of BHRT.
- While BHRT is derived from plant-based substances, it goes through an intense synthesizing process to chemically alter it into a pharmaceutical-grade substance, therefore removing many of the “natural” properties that once existed.
BHRT Is Not Thorough Enough
While BHRT can be helpful for some women with specific conditions for short periods in small doses, there is more to consider when treating a patient. If a patient’s lab report indicates that they are low in certain hormones, it is not best to simply treat the patient to raise their hormone levels back to an optimal range. Instead, the first question should be to consider why the levels are low in the first place.If the hormonal cascade is not working properly, and a woman’s body is not properly converting precursors, treating low levels of hormones with BHRT may not solve the issue.
HPTAG Axis Suppression
BHRT can be extremely effective in relieving negative symptoms for women in menopause. As always, it is important to monitor hormone levels regularly in order to observe what is occurring in the body. Long-term use of BHRT can actually worsen the problem by causing negative feedback loops within the hypothalamus-pituitary-thyroid-adrenal-gonadal axis (HPTAG axis). The HPTAG axis is a complex communication network between the brain, endocrine glands, hormones, and neurotransmitters that controls cellular activity, growth, metabolism, stress response, reproduction, general homeostasis, and various other functions.Essentially, HPTAG axis suppression means that the pituitary gland recognizes the higher hormone levels from long-term BHRT use and signals the body to stop producing those hormones on its own. This can lead to hormone resistance, as the body becomes accustomed to high levels of hormones without having to work to produce them.
Why Might BHRT Be Helpful for Me?
BHRT in small, controlled doses over a brief period can be extremely helpful in eliminating undesirable menopause symptoms for some women.When a woman’s ovaries are no longer releasing eggs, they are also no longer producing estrogen or progesterone. This leads to dramatic hormonal changes resulting in many of the common menopause symptoms. BHRT may help to balance estrogen and progesterone levels in the body, relieving symptoms for some.
Additionally, supporting the adrenals before and through all stages of menopause is crucial to managing hormone levels. If someone has an unsupported thyroid condition, the body depends more heavily on adrenals, as the thyroid is intimately involved with hormone function. Menopausal symptoms arise when a woman is already depending on adrenals for hormones. BHRT can be effective in taking strain off of the adrenals and allowing them time to repair in order to produce the appropriate levels of hormones once again.
Do I Have the Correct Hormone Replacement Therapy Dose?
It is vitally important to keep a close watch on hormone treatments to ensure they are being safely and effectively used.After treatment begins, the clinician should follow up with testing in six to eight weeks and have maintenance check-ins to keep a close eye on hormone levels. Retesting hormone levels once on BHRT is especially critical. Hormones can elevate to dangerously high levels, which can predispose women to endocrine-based cancers.
Additionally, choosing a skilled provider is key to having success with hormone replacement therapy.
Functional Alternatives to BHRT When Walking Through Menopause
The functional approach to menopause and overall hormone health focuses on healing and restoring a woman’s proper physiological balance to the endocrine system. It’s important to work with a provider to support the body to be stable throughout menopause.This approach includes evaluating:
- Individual hormone levels.
- Thyroid health.
- Exposure to endocrine disruptors and other environmental toxins.
- Blood sugar regulation.
- Adrenal health and stress.
- Nutrient deficiencies.
- Liver and gut health.
- Genetics.
To learn about the essentials of menopause read Part 1: A Quick, Essential Guide to Menopause
To learn about how menopause affects your blood sugar read Part 2: Menopause, Blood Sugar, and Weight Management
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