Menopause is not just about hormones. Dr Bernard Brom takes a look at the relationship between the hormones, where and how imbalances can arise, and ways to manage menopausal symptoms.
Perimenopause is the phase before actual menopause, when the menstrual cycle becomes irregular and hormone levels fluctuate. Symptoms and signs of perimenopause may continue after the menses stop.
Menopause is the complete cessation of menstrual bleeding for a period of 12 months in the absence of any other cause. This usually occurs between the late forties and the mid-fifties.
What your doctor may not tell you. Menstrual bleeding may stop completely, but this certainly does not mean that menopausal symptoms just stop. The symptoms and signs that start with perimenopause may continue even after menopause, as defined above. The menses stop because of the fall in hormones, but if symptoms continue, what is really going on?
SYMPTOMS OF PERIMENOPAUSE AND MENOPAUSE
These include hot flushes, night sweats, insomnia, vaginal dryness, aching joints and muscle problems, anxiety, irritability, depression and mental fatigue, decreased libido, headaches, migraine, heart palpitations, urinary tract infections, weight gain, hair loss and incontinence.
What your doctor may not tell you. Not everyone has these symptoms, even if their hormone levels are falling as dramatically as those of a woman who is experiencing true menopausal misery.
Menopause is about more than hormones. Hormones are clearly involved, but until we understand much more about the controls behind their fluctuations, the influence of mind over body and electromagnetic shifts in the body, we should not attribute menopausal symptoms solely to a drop in hormone levels.
IS MENOPAUSE A HORMONAL PROBLEM?
The general impression among lay people, an impression entrenched by the medical profession’s dogma, is that menopause is a hormonal problem and results from a decrease in the sex hormones – oestrogen and progesterone.
I would like to show that this is erroneous and an oversimplification. Most women know other women, often their mothers or grandmothers, who sailed through menopause and lived to a good old age without any problems. The fact is that all women who live long enough will experience a fall in their sex hormones (and many other hormones), but only a certain percentage will have the symptoms of menopause.
SOME FACTS ABOUT HORMONES
As you read, note the various factors that can become blocked and be interfered with, and how symptoms and signs can potentially develop.
- Oestrogen is not a single hormone – it’s actually three hormones, with similar structures but not exactly the same functions. These three hormones are called oestradiol, which is the most powerful and dominant female hormone and is kept tightly controlled; oestrone, the dominant form in the postmenopausal woman, produced in the ovaries and fat cells; and oestriol, secreted in large amounts by the placenta and regarded as a weak oestrogen – it’s the one least associated with hormone-related cancers. The only form that conventional doctors prescribe is oestradiol. Integrative practitioners, on the other hand, like to use all three in a specific ratio.
- Strictly speaking, progesterone is not a sex hormone in the same way oestradiol is. If you look at biochemical pathways you will discover that progesterone appears very early in the cascade of events that leads to the appearance of oestradiol. Oestradiol is what I like to call an ‘end-point’ chemical event, while progesterone is made much earlier (from cholesterol, the mother chemical structure).
Why is this important? The higher up a chemical is in the cascade of events, the more likely it is that it can be deviated to other pathways – and this is what happens to progesterone. Under extreme stress, for example, progesterone is deviated to making adrenal stress hormones such as cortisol. Stress can therefore shift the balance between progesterone and oestradiol, and chronic stress during the menopausal period can lead to an aggravation of symptoms.
- Even if a woman has sufficient sex hormones, they cannot produce effects without receptor sites to accept them. A key is useless without the lock, and hormones and their receptor sites are like a key and lock. Many things can block receptor sites, interfering with the hormones’ ability to latch on. The oestrogen receptors in particular are not as fussy as many other receptor sites, which are very specific about what they allow to become attached to themselves. This means that the oestrogen receptors allow not only the body’s own natural eostrogen but also foreign chemicals from outside the body (xeno-oestrogens) and many herbal products, with similar structures to oestrogen, to bind to them. This receptivity can be taken advantage of by practitioners who use herbs to ‘decrease’ the power of oestrogen if necessary, but it can also have negative consequences if oestrogen is blocked in a haphazard way by the toxic chemicals found everywhere in our environment and in our food chain. We do not yet know how everything functions as a whole, and I am very cautious in prescribing hormones unless they are bio-identical to the body’s own natural hormones (more on that later).
- It is well known that the bones reach maximum density in the early twenties, and then begin to lose calcium during a time of maximum oestrogen levels.
- Women with normal oestrogen levels may have major perimenopausal symptoms.
- Another apparent paradox is that while oestrogen decreases dramatically after menopause, the incidence of breast cancer slowly increases, and there is also evidence that women taking hormone replacement therapy (HRT) have an increased risk of breast cancer. This could suggest that the body’s own oestrogen may protect a woman from breast cancer, but that HRT does not do the same thing.
- All the sex hormones fall with menopause. These hormones are manufactured from cholesterol, so as the hormones decrease, it is completely natural for cholesterol to rise as we age. Doctors tend to use statins to bring cholesterol under control, yet its increased level may be a natural response to falling hormone production.
- Oestrogen, as we have seen, is an ‘end product’ of a long chain of biochemical events. It is a very powerful hormone that the body likes to keep under tight control and remove as soon as possible. This ‘detox’ process happens in the liver, and during it oestrogen passes through a number of stages. There is evidence that some of these early ‘metabolites’, i.e. breakdown products, are very toxic and even carcinogenic. The body will obviously try to remove these metabolites as soon as it can, if the liver has all the nutrients it needs to make the necessary conversion.
HOW DO THINGS GO WRONG?
- Problems can arise when xeno-oestrogens or chemicals from the environment are able to block oestrogen receptor sites, preventing the natural oestrogen with its unique message from getting to the cells. Think through this carefully. The xeno-oestrogens block the body’s oestrogen signals, and replace them with signals of their own. You know how easy it is to misinterpret what someone is saying to you when they have a slight accent – the same happens in the body. It’s similar ‘language’, but not the same.
- Every chemical process in the body, including the complex biochemical progression of cholesterol to progesterone to oestrogen, and then the whole detox process, depends on a wide range of cofactors that function as enzymes to speed things up. Vitamins and minerals are essential in the production line; pH is vitally important; mitochondrial function is essential for energy production; and so on. A deficiency of nutrients anywhere along this chain of events can have profound effects on hormone production and responses.
- HRT requires special consideration, for the reason that it is the standard approach to dealing with menopause. There are a number of crucial issues here that need consideration.
HRT AND MENOPAUSE
If I criticise the unquestioned prescribing of HRT, which works by latching onto the oestrogen receptor sites and triggering signals, it is because I believe that the signals are not exactly the same as those from natural hormones. This is supported by the fact that each of the synthetic hormones used in HRT produces slightly different responses in the body, and causes slightly different side effects. How does HRT compare with natural bio-identical hormones, and what about herbal products with hormone-like actions, which also latch onto the oestrogen receptor sites?
Bio-identical hormones are produced in laboratories from the wild yam. Note that wild yam itself does not have hormonal properties, but the hormones can be manufactured from the yam. The extraction is a chemical process, but the end product, whether it is oestrogen or progesterone or even testosterone, is biochemically exactly like the body’s own hormones. Integrative doctors use these hormones extensively to top up any deficiency of hormones in the body. I think this is a valid way to use bio-identical hormones, and provided a person is taking them responsibly (under the care of a health practitioner), they are pretty safe and healthy. The signals they produce will be the same as those from the body’s own hormones.
Herbal products or their isoflavones, such as red clover, black cohosh, and soya isoflavones do not have the power of HRT or even the bio-identical hormones, and are regarded as having weak ability to attach to receptor sites. This is actually a good thing, because it means they support the body’s own hormones when these are lacking, and act in unison with them. Numerous scientific studies affirm their ability to increase oestrogen effects when these are weak as a result of deficiency of oestrogen. The red clover isoflavones, for example, have been found to preferentially activate the beta-oestrogen receptors in the brain, bones and cardiovascular system, with very little activity in the alpha-oestrogen receptors in breast and uterine tissues.
HRT is very different from the above. It may have a place when nothing else has worked, but I don’t believe that it should ever be the first approach. Let me explain why. First, let’s separate bio-identical HRT from non-bio-identical HRT. If HRT is not bio-identical, it is a foreign substance with a powerful chemical structure that has powerful hormone-like effects in the body.
I am generally against the use of ‘power’ in the body, and overriding the body’s natural intelligence, even when the body is clearly asking for help. Going into battle shooting haphazardly with big guns is as likely to kill your friends as to kill your enemy. Supporting your friends and finding out who they are requires a more gentle approach. I think this is why progestins, which are often pushed forward as similar to progesterone, have now been associated with an increased incidence of breast cancer. Make sure that your doctor explains whether what you are being prescribed is natural progesterone or a chemical progestin which is not bio-identical.
Doctors do have the option of using natural bio-identical oestrogen, although not all the oestrogen they use is bio-identical. This comes in tablets, capsule form or patches and may or may not be combined with a progestin.
Oestrogen – pills or patches? There are problems with oral oestrogen, even if it is bio-identical to the body’s own oestrogen. Anything taken orally must pass through the liver, which will immediately start breaking the oestrogen down. In order to get enough oestrogen into the bloodstream, doctors have to prescribe the oral form in high amounts, so that enough manages to get through the liver into the bloodstream. This makes sense, but the trouble is that the more oestrogen there is, the more toxic breakdown products the liver will produce. This is why oestrogen patches were developed. If the patches contain only natural bio-identical oestrogen without progestins, they are pretty safe. The oestrogen in the patches, just like the bio-identical hormones in oestrogen and progesterone creams, passes directly into the bloodstream and can start doing its job without having to go through the liver first.
INTEGRATIVE MANAGEMENT OF MENOPAUSE
As I have stated above, many women go through menopause without any symptoms despite the fact that oestrogen, progesterone and testosterone levels fall in all women. Clearly the symptoms of menopause are not just a result of this decrease in hormones.
Perhaps the most important reason for the symptoms is what menopause expert Dr John Lee calls ‘relative oestrogen excess’. As a woman moves towards menopause she tends not to ovulate every month (this explains why she becomes less fertile as she ages). Without ovulation there is no formation of the corpus lutuem, which is required for increased production of progesterone. Long before oestrogen begins to decline, progesterone has begun to decrease. As ovulation stops, menopausal symptoms occur. Integrative doctors therefore believe that the reason for menopausal symptoms is a relatively high level of oestrogen compared with progesterone.
There are various ways to respond to this situation. Using phyto-oestrogens (plants and herbs) may be enough to block the oestrogen receptors with weak oestrogen, thus lowering the effects of oestrogen; or integrative doctors may prescribe natural bio-identical progesterone to increase the level of progesterone and improve the ratio between oestrogen and progesterone.
There are also many herbal formulas that are safe to try. They help to even out the oestrogen/ progesterone ratio, support adrenal and thyroid function, and calm the system. A good vitamin and mineral combination is helpful to supply the co-factors required for metabolic functions, and antioxidants are important for reducing the free radicals often produced during this period.
Lifestyle changes are essential, as is a shift in attitude to these changes. Menopause is not the beginning of the end, but the beginning of a process leading to greater maturity, greater freedom for sexual expression, and discovery of what the new journey is all about. It’s a time to shift from ‘hot flushes’ to ‘power surges’.
Exercise and meditation are all-important. Your diet should be low in refined carbohydrates, but check what your carbohydrate limits are. Some women should really try to avoid all grains and coffee.
Learn to be light-hearted, even when you find it difficult. Your body needs all the encouragement it can get.
Editor’s note: Another excellent article on how to heal your hormones is the one by Dr Ruth Hull. Click here to read.