Menopause – Definition and Stages
Menopause, traditionally, is known as the cessation, or, a stopping, of the menstrual cycle. Menopause actually has three phases: peri-menopause, menopause and post-menopause.
Peri-menopause lasts for about 2-8 years before the complete cessation of the menstrual cycle (period). In many women, this is the time when things start to change. The earliest sign is usually irregular, long or short periods with heavy or light bleeding. Some other well-known menopausal signs can appear in this stage, like hot flashes, insomnia and weight gain. This is because the primary hormone levels are slowly decreasing while other hormones tend to increase.
True menopause refers to the complete end of the menstrual cycle for a year in the absence of any other cause. The average age of menopause is 51 years old. In this stage, reproduction capabilities have ceased.
Post-menopause is often referred to the time after menopause when the woman’s symptoms are alleviated. There doesn’t seem to be a clear distinction between the three phases. This is likely because there is significant overlap in the symptoms and clinical observations.
Throughout this post I will collectively refer to these stages as menopause.
Estrogen and Progesterone
There are a few hormones in the woman’s body that are closely related to the changes that take place during menopause. Two of these hormones are estrogen and progesterone. When talking about menopause, we are talking about lower levels of these hormones. However, we are also talking about all the structures and organ systems that normally use these hormones for proper function.
Progesterone is essential for fertility and maintaining pregnancy in a woman’s child-bearing years. It’s benefits also include breast health, brain, nervous system and cardiovascular health. In the brain, progesterone is used for optimal brain function and for healing and repair of the brain in traumatic brain injuries. It is also used as a sleep aid and it eases anxiety. This hormone also declines in the menopausal years.
Estrogen is made in the ovaries of the female and the testes of the male. It is also produced in small amounts in other places in the body. Estrogen is almost exclusively recognized for its role in reproduction and bone health.
We know that specific cells use estrogen because those particular cells have receptors that are used only for estrogen – like a puzzle piece. An estrogen receptor is a binding site, where the estrogen attaches to and signals the body to bring about a specific function. Estrogen binding sites are found in the nervous system (brain, nerves), the endocrine system (glands that produce hormones), the skeletal system (bones), the lipid (fat) cells and the cardiovascular system (heart, blood, blood vessels and lymph). These organ systems can be affected by the change of estrogen levels that occurs in menopause.
As a woman enters the second half of her life, estrogen and progesterone decrease in her body. Sometimes the levels of progesterone decrease so much that the body thinks that estrogen is actually too high. The ratio of estrogen to very low progesterone can actually trick the body into thinking it has too much estrogen. This is called estrogen dominance and has the signs and symptoms of menopause.
It is known now that changing hormone levels are likely just a part of the picture – and, not necessarily the only cause. Additionally, other factors like chronic stress, pre-existing conditions and nutrient deficiencies may all impact symptoms and wellness during menopause.
The Roles of Estrogen
Estrogen plays a role in metabolism. Metabolism is the set of processes that take place to sustain life. It also contributes to the homeostasis required throughout the body. Homeostasis refers to balance and equilibrium of all cells and organ systems.
Metabolism, therefore, generates energy from her food intake, her fat storage and excess weight, and, even the function of leptin, which is the hormone that tells us when we are full or hungry. As you can imagine, a decline of estrogen, then, can result in these important processes going ‘out of balance.’ It is not only easier to gain weight around the middle (stomach), it is also much more difficult to lose weight (metabolism). The mechanisms the body has used in the first half of the woman’s life to manage food intake, create energy and manage lipid (fat) storage has completely shifted.
Estrogen is also instrumental in glucose (sugar) regulation. As a woman gets older, it is common to see a rise in her fasting glucose levels. In menopause, it is even more important to avoid all foods like sugar and simple carbohydrates. The glucose regulatory system no longer has sufficient estrogen to adapt to high glucose levels. This leads to a higher risk of the development of insulin resistance and Type 2 diabetes.
The increase of cardiovascular disease risk in menopause is well established in the literature. It is not known in the scientific world exactly how the risk factor for cardiovascular disease increases. It is hypothesized that the role of the declining hormones coupled with poor diet and exercise, not enough sleep and chronic stress play a part.
Estrogen is a factor in immune function. Immune cells have estrogen receptors as well. Some women find out that they are less likely to recover from an illness quickly. When the immune system is compromised, it opens the door to the development of disease and infections and, likely autoimmunity.
Circadian rhythms and Sleep
Estrogen plays a role in circadian rhythms and sleep. Circadian rhythm refers to the internal cycle of sleep (rest, repair, restoration) and wakefulness (energy, life). The body actually relies on different circadian rhythms in many systems in the body. When this hormone begins to decline, one of the most common complaints women have is sleep issues like insomnia.
Symptoms of Menopause
The long list of symptoms of menopause are not surprising considering the hormones’ effects. The symptoms include hot flashes, fatigue, mood issues like depression and anxiety, incontinence, vaginal dryness, heavy bleeding and insomnia. Hot flashes, night sweats and some other signs are vasomotor symptoms and are associated with higher risk of cardiovascular disease. Vasomotor refers to the actions on a blood vessel which changes its size (dilation).
As a clinician, I always recommend a number of different approaches for menopause because this is not just about getting rid of the symptoms, but, also attempting to discover what other factors may be affected. For example, if the woman is experiencing menopausal symptoms, but her blood tests also show high fasting glucose (sugar), we would know to consider more factors in treatment.
Proper nutrition from dietary sources initiate balance and healing. Hormone-healthy foods like greens, broccoli, kale and other leafy vegetables should be a staple in the diet. Foods like flax seed, sesame seed, lentils, beans, tofu, soy and berries have compounds called phytoestrogens. These compounds are thought to act as a natural estrogen in the body. Healthy fats, like olive oil and avocado promote optimal hormone levels, anti-inflammatory benefits and mood balance. An interesting fact is that menopausal symptoms are far less known in the Mediterranean culture. It is hypothesized that their diets which are high in olive oil and vegetables are the reason for this.
Thirty minutes of exercise is especially beneficial in cardiovascular health. It also decreases the risk of osteoporosis, improves immunity, helps with weight management and is useful for restful sleep. Every system listed above that has estrogen and progesterone receptors will be improved with daily exercise. A combination of aerobic exercise, weight training and flexibility training are absolutely crucial in the management of menopause.
All the systems in the body are intricately connected, and, the stress adaptation system often seems to be central in imbalance and the progression of disease. It is known that stress does, in fact, exacerbate night sweats and hot flashes. Chronic stress can be alleviated with daily calming practices and meditation.
Botanical (Herbal) Nourishment and Support
Botanicals have been used to help with all the unwelcome symptoms associated with menopause. Herbal remedies have a long history of safety and efficacy.
Chaste Tree (v.agnus-castus) has been used for generations to support optimal female hormone health. Black cohosh (Actaea racemosa), valerian root (Valeriana officinalis), peony (Peonia suffruticosa) and motherwort (Leonurus cardiaca) are also great additions.
The most common botanicals for this is black cohosh(Actaea racemosa), sage (Salvia officinalis), red clover (Trifolium pratense), motherwort (Leonurus cardiaca). Valerian (Valeriana officinalis) can be used as well especially if you are also suffering from insomnia.
Depression and Anxiety
Because depression and anxiety are often exacerbated by stress – the herbals that work for both of these issues are often chosen. These include ashwagandha (Withania somnifera), ginseng (Panax ginseng), curcumin (Curcuma longa), motherwort (Leonurus cardiaca) and dong quai (Angelica sinensis).
Valerian (Valeriana officinalis), chamomile (Matricaria chamomilla), passionflower (Passiflora L.), St. John’s wort (Hypericum perforatum) are great botanicals for helping with sleep and stress.
Herbal blends, as recommended by a trained herbalist, are the best course of action because she/he can blend botanicals that will be beneficial specifically for that person.
A Word about Hormone Replacement Therapy
Bio-identical hormone replacement therapy (BHRT) is customarily the treatment approach for menopause in the functional medicine paradigm. There are risks to all hormone replacement therapies (HRT), even the bio-identical approach. In my opinion, this should be a last resort where all other treatment and recommendations have been exhausted.
In some cases, it seems sensible to use bio-identical HRT. When the woman’s symptoms are so overwhelming and overpowering that it causes too much chronic stress and reduced quality of life, short term hormone therapy will be helpful. However, the patient and clinician should recognize that, since BHRT is not recommended for long term usage, there will likely be a “menopause” phase to go through when the hormone dosing is stopped.
Endocrine Failure or Intelligent Design?
I, as well as hundreds of other clinicians, have studied thousands of articles that have been published in the literature. I am often humbled and amazed at the intricate perfection and design of the body in its healthy state. Menopause is healthy. This is not the beginning of the end. It is a natural transitional stage of every woman’s life. Knowing that, women should be encouraged to arise from the victim mentality of the medical model.
A Healthy Body Doesn’t Make Mistakes
In her textbook, Botanical Medicine for Women’s Health, Dr. Romm speaks about Reframing Menopause. She writes about the modern, medicalization of menopause and presents the concept of reframing menopause.
The medical model views menopause as an endocrine disorder that should be medically treated “with the seriousness of other endocrine disorders.” This viewpoint is shared by the natural medicine model as well as the modern medicine one. It seems to define the older woman as one who is in a state of loss, a victim of menopause.
In contrast, the Wise Woman tradition is centred around the nourishment of the whole woman. It defines menopause as a natural event occurring over several years, during which the hormonal and nervous systems undergo profound changes. This model is focused on encouraging the woman to embrace this time of change and live her life with conscious acceptance of the gift of menopause.
You have a choice, Woman, to reframe your thinking. If you are still young, you have a chance to look ahead – not with a heart of fear and dread, but with anticipation of the next amazing mystery of the woman’s life. If you are starting menopause, or in the midst of it, embrace the gift you have been given. Nourish your body with nutrition, meditation, sleep and supportive herbals. If you need to, reach out to other women who can support you. Take time alone for your mental and physical health. Find ways of serving others while taking care of yourselves.
Reframing Menopause using these supportive principles are often sufficient to stop mild to moderate symptoms experienced during this time. It will provide long-term health for the whole woman.
The Role of Estrogens in Control of Energy Balance and Glucose Homeostasis
The role of estrogen receptors in the control of energy and glucose homeostasis.
Metabolism Regulation by Estrogens and Their Receptors in the Central Nervous System Before and After Menopause
Clinical Answers for optimization of hormones, serotonin and other neurotransmitter imbalances.