Menopause

Menopause is the natural process of midlife cessation of ovarian function — even the best of health habits will not prevent it from happening. Though menopause is not a disease, it can make life quite miserable.

Symptoms of menopause result from disruption of the hypothalamic-pituitary-adrenal axis (HPA axis for short).

The hypothalamus is a walnut-sized gland at the base of the brain that controls sleep and wake cycles, body temperature, stress tolerance, energy and metabolism, and body weight. It does so by regulating the pituitary gland, which, in turn, regulates the thyroid gland (metabolism), the adrenal glands (stress glands), and the ovaries (reproduction).

In a normal menstrual cycle, the hypothalamus regulates ovarian function by continually sensing and adjusting the amount of estrogen being produced by the ovaries. During the transition through menopause, the ability of the ovaries to produce estrogen fluctuates wildly and then gradually declines.

Changing levels of estrogen send abnormal feedback signals to the hypothalamus. The imbalance causes disruption of all hypothalamic functions. Disruption of hypothalamic function also disrupts adrenal function and thyroid function. Not surprisingly, poor sleep, weight gain, hot flashes, and intolerance to any type of stress are the most common symptoms of menopause.

It should be noted that imbalance in the HPA axis causing symptoms is related to changes in estrogen, not absolute decline in estrogen. Once the ovaries stop producing estrogen completely and hypothalamic functions return to a steady state, symptoms gradually resolve.

Solutions for Menopausal Symptoms

Restarting the ovaries is, of course, not possible, but there are practical ways of re-balancing the hypothalamus until symptoms resolve. One of the most direct ways is by adding estrogen. Estrogen can be given orally, by injection, and transdermally (creams, gels, and patches). Because estrogen is not absorbed well orally, synthetic estrogen preparations are most often used for the oral route.

The problem with estrogen is that sometimes very high servings of synthetic estrogen must be used to override fluctuating estrogen production by the ovaries and rebalance the HPA axis. This raises the concern of over-stimulating estrogen receptors in the breast and stimulating cancer formation.

Estrogen must be accompanied by progesterone to prevent overstimulation of the lining of the uterus and bleeding. Progesterone, given by itself, can sometimes help balance the HPA axis and reduce symptoms. Use of progesterone alone will not cause problems in the uterus or breast.

Another option for rebalancing the HPA axis is taking phytoestrogens. Phytoestrogens are plant hormones that have similar properties to estrogen. Most phytoestrogen products are derived from soy or red clover. Because phytoestrogens only have about 1% activity of human estrogen, a lot of phytoestrogens are required to get a response — possibly enough to stimulate estrogen receptors in the breast to a concerning level.

For those seeking a non-hormonal option, a combination of ashwagandha, l-theanine, and two calming herbs, magnolia and phellodendron, can do wonders.

The biochemical components of ashwagandha are well known for balancing hypothalamic functions and reducing symptoms associated with menopause — without any hormonal effect. Ashwagandha is also known to support normal thyroid function and balance adrenal hormones.

A combination of the Chinese herbs, magnolia and phellodendron species, are known for supporting adrenal function and increasing stress tolerance.

L-theanine is an amino acid found in green tea. It has the unique property of counteracting stimulating neurotransmitters in the brain, thus encouraging a state of calm and focus, without being sedating.

If symptoms are persistent, however, the next step is the addition of natural progesterone cream.* Progesterone cream does not require a prescription. Most products provide 20 micrograms of natural progesterone. Generally about 20-40 micrograms twice daily is required to control symptoms.

If those measures do not control symptoms, estrogen or phytoestrogens can be added with progesterone. Estrogen products require a prescription from a doctor, but phytoestrogens do not.

All estrogen products are not equal. Synthetic estrogen preparations are extremely potent and strongly stimulate estrogen receptors in the breast. Natural transdermal bioidentical estrogen/progesterone preparations (obtained by prescription from a compounding pharmacy) are safer and have a more natural effect, but are not as potent.

If that doesn’t do it, consider asking your healthcare provider about natural transdermal bioidentical estrogen/progesterone options.

In addition, good health habits go a long way toward helping to rebalance the HPA axis during menopause. Lots of vegetables, low-processed carbohydrates, moderation of stress, and regular exercise can help ease the transition through menopause.