Integrative approaches to menopause


Sharpen your understanding of hormonal balancing and estrogen level management.

The transition to menopause can be a time of reflection and inspiration. Although transitions of any kind can be inherently difficult, many women experience a newfound sense of freedom and personal growth during menopause. As one author put it: “Menopause is a time of great change — it is the adolescence of older age but better than the adolescence of youth because menopausal women have confidence and experience.”

Women begin to experience hormonal changes beginning in their late 30s to early 40s; however, many women do not realize that their symptoms are from hormonal changes. Hormones fluctuate during the lifetime and the menstrual cycle.

Hormone therapy is an $840-million industry: Approximately 8 million women are receiving supplementation with synthetic hormone therapy using ethinyl estradiol and progestin. There are 6 million women who use synthetic estrogen alone. Over 2 million women are currently using hormone therapy, and many are obtaining relief from their symptoms.

Synthetic hormones, known as “patented,” “conventional,” or “artificial,” are produced from products that are usually not found in nature, or at least not in humans. This is because natural sources cannot be patented. The substances are chemically altered from human hormones, but not identical in structure or activity to the natural hormones they emulate.

The most commonly prescribed hormone replacement in the U.S. contains a mixture of equilin and equilenin, along with other additives that are synthetic. These additives and coatings may cause their own side effects including burning in the urinary tract, allergies, joint aches, and pains. Synthetic estrogens contain many forms of estrogen that do not fit into the estrogen receptors in the body.

In 2002, the Women’s Health Initiative (WHI) study was released. The study was a major 15-year research program to address the most common causes of death, disability, and poor quality of life in postmenopausal women; namely, cardiovascular disease, cancer, and osteoporosis. During the first year of the study, there was an increased risk of heart disease, but over a six-year-period the women actually had a decreased risk of heart disease.1 The actual risks in the study equated to eight more breast cancers, eight more strokes, seven more heart attacks, and 18 more blood clots per 10,000 women.

“Estrogen” is a commonly used term that includes three different types of estrogen. Prior to menopause, the body produces 80 percent estriol, 10 percent estradiol, and 10 percent estrone. Once women go through menopause, the ratio of estrogens change and the body produces 80 percent estrone, 10 percent estriol, and 10 percent estradiol. Estradiol is the hormone best known for managing menopausal symptoms.2

During the WHI study, women were provided with estrogen in oral form. Oral estrogen creates problems in postmenopausal women because this estrogen converts to estrone.

A common estradiol of 1 to 2 mg actually produces urinary excretion of 16 hydrox-estrone at levels five to 10 times higher than the normal range.3 These metabolites are known for increasing the risks of breast cancer if the body is unable to excrete them properly. The impact of the most potent carcinogenic metabolites can be controlled in most patients with cruciferous vegetables and their active components.4

The WHI study also indicated that synthetic progestins contribute to increased risk of cancer. Other studies like The Million Women Study showed a doubled risk of breast cancer in women using progestins.5

Many of the women who are given hormone replacement therapy are severely overdosed with hormones, which increases their risk for various cancers. It is important for postmenopausal women to undergo appropriate hormonal testing. There are various methods of testing hormones, some believed to be more accurate than others.

Blood testing is the most common form of testing used by conventional practitioners. This type of testing is usually easy for the patient, and it is often covered by insurance. However, the method needs to be adjusted based on a woman’s age and whether or not she is menstruating. Salivary testing is the most common type of testing performed by functional medicine practitioners. There are various companies that provide these services, and it is important to find one that uses an extraction method.6

A variety of hormones can be tested via saliva or blood. It is important to test estrogen, progesterone, DHEAs, and testosterone. Whenever possible, testing free hormones is preferred. Only testosterone and DHEAs are available in free form with blood testing, therefore salivary testing is the preferred method as it allows free hormone testing with all of the hormones.

Treatment options can vary from bioidentical hormone therapy (BHRT) and synthetic hormone replacement to herbal therapy. Herbal therapy provides the safest option for women concerned about cancer risks. Bioidentical hormones can be used safely if the body eliminates the estrogen metabolites and excess hormones so they do not store in the body’s fat tissue. Studies show that cruciferous vegetables can impact the most toxic estrogen metabolites, thereby reducing the risks for breast cancer.4

Every postmenopausal woman has a variety of symptoms that can result from different hormonal imbalances. These symptoms may be from imbalanced estrogen and progesterone, or from imbalances in adrenal function. Hot flashes are commonly thought to be a result of low estrogen, but they can also occur from adrenal insufficiency.

It is important to test hormone levels because symptoms can overlap and make it difficult to identify which hormone is causing which specific symptoms. Progesterone excess can provoke symptoms of estrogen deficiency such as hot flashes, night sweats, and vaginal dryness.

Key supplements can be used as a basic protocol for all menopausal women: cruciferous vegetables, white peony, schisandra, shatavari root, ginseng, ashwaganda, wild yam, and rhodiola. These herbs support the endocrine system, focusing on the adrenal glands and ovaries. Also, most women living in the northern regions of the country need vitamin D supplementation (which is actually a hormone, not a vitamin).

Other supplements that can be helpful are vitamins C, B, and E; the minerals calcium and magnesium; DHEA; and evening primrose oil. Practitioners who purchase these items need to evaluate the makers’ use of quality raw ingredients and good manufacturing practices.

Women who experience hot flashes can often get relief by taking iodine supplements on a daily basis. Adding sufficient black currant seed oil, which is a good source of gamma-linolenic acid (GLA), to the diet can also greatly reduce hot flashes (because many people cannot convert linoleic acid to GLA).

For each menopausal woman, a complete history should be taken and an individual protocol created based on the presenting symptoms. If you are new to treating women with hormonal imbalances, find practitioners who are willing to mentor you, or attend seminars that teach the practice of hormonal balancing.

Debra Muth, ND, RN, WHNP, BAAHP, specializes in hormone balancing through an integrative approach using nutrition and whole food supplements. Muth lectures across the country and is a contributing author to the book Audacious Aging. She was recently listed among the top naturopathic practitioners in the greater Milwaukee area where she practices.

Reprinted with permission from Vol. 57, Issue 7 (May 9, 2011), of Chiropractic Economics

References

1 Psaty BM, Smith NL, Lemaitre RN, et al. Hormone replacement therapy, prothrombotic mutations, and the risk of incident non-fatal myocardial infarction in postmenopausal women. JAMA. 2001;285:906-913.

2 Longcope C, Gorbach S, Goldin B, et al. The metabolism of estradiol; Oral compared to intravenous administration. J Steroid Biochem. 1985;23:1065-1070.

3 Friel PN, Hinchcliffe C, Wright JV. Hormone replacement with estradiol: conventional oral doses result in excessive exposure to estrone. Altern Med Rev. Mar 2005;10(1):36-41.

4 Lord RS, Bongiovanni B, Bralley JA. Estrogen metabolism and the diet-cancer connection: rationale for assessing the ratio of urinary hydroxylated estrogen metabolites. Altern Med Rev. 2002;7:112-29.

5 Beral V, Million Women Study Collaborators. Breast cancer and hormone-replacement therapy in the Million Women Study. Lancet. 2003 Aug 9;362(9382):419-27.

6 Stanczyk FZ, Cho MM, Endres DB, et al. Limitations of direct estradiol and testosterone immunoassay kits. Steroids. 2003 Dec;68(14):1173-8.

Debra Muth ND, RN, WHNP, BAAHP and reprinted with permission from Vol. 57, Issue 7 (May 9, 2011), of Chiropractic Economics

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Last revised: 27 November 2017
Next review: 27 November 2020