The human female is no stranger to change. A woman’s body is designed to transform itself repeatedly throughout her lifetime particularly within the complex tapestry of her reproductive system. At birth, a female baby is born with between two to four million oocytes (immature eggs) in her ovaries, by age 7 the number has reduced by a natural process called atresia to 400,000 eggs and slowly over the next few years her young body is exposed to more and more estrogen to the point of menarche around the age of 12. Rhythmic monthly changes ensue with the menstrual period and can persist in their cyclic variations for one to three decades before a possible conception occurs. If conception occurs, female humans are exposed to massive hormonal changes during pregnancy due to the emergence of the placenta, a hormone producing organ of extraordinary measure. The birthing process exposes the female body to more hormonal changes over the course of up to a day or more which results in yet another hormonal picture change with breastfeeding. Nursing hormones can last for years before either another conception, pregnancy and delivery occur or the cyclical changes of menstruation start up again. The healthy human female body responds to this vast array of change with aplomb.
And then comes along menopause. The menopausal transition is marked by an array of physiological alterations so fundamental they have been referred to rather ominously as “The Change”, as if the female body hasn’t already been through decades of changes. The premise of this article is that the physiological transitions which occur over the menopausal years can be managed by the female body as smoothly and easily as those changes described above in the earlier years. As in the younger years of a woman’s life, it all depends upon the backdrop of health upon which those changes take place. Women’s bodies are designed to flow with transition.
The Change, also called the Climacteric, includes perimenopause, menopause and post menopause. Each stage has a distinct hormonal profile that gradually shifts to the next stage. The hormonal shifts occur from roughly age 35 to age 60. This change takes time. The female body is so well-adapted to this change however that it is possible to go through these changes barely noticing that anything of major significance is happening save the stopping of the menstrual cycle.
Before describing each of these three distinct phases of the menopausal transition, it’s important to understand that they do not occur in a vacuum. Of all of the processes in the body, reproductive health is strongly dependent upon total health. Chinese Medicine theory recommends that the menstrual cycle be addressed last in the treatment progression because if other imbalances are corrected, menstrual issues tend to disappear. Said another way: if there are menstrual or hormonal issues, this suggests that there are often more generalized imbalances at play. Some menstrual or hormonal imbalances are primarily ovarian in nature but less often than might be suspected. In such cases, bioidentical hormone therapy may be indicated.
In a nutshell, if your liver is detoxifying effectively and you are making plenty of healthy bile, your thyroid gland is functioning optimally, your adrenal glands are in top shape, your gastrointestinal tract lining is intact, your blood sugar is balanced, your bowel movements are regular, you have a robust gut microbiome and your neurotransmitters are firing as they should, then your overall health will be excellent and the changes of perimenopause and menopause can proceed without many issues. If these fundamental systems are in less than optimal health, the menopausal change can be more difficult just like menstrual issues such as PMS can more extreme when background health is out of balance. For example, I often see women in their 40s who are having hot flashes and the assumption is that this is entirely a perimenipausal symptom. Although perimenopausal changes may be occurring, when we support liver detoxification and correct leaky gut issues, the hot flashes go away. I see this time and time again. What concerns me most is that many of these women may have turned to hormone replacement therapy for hot flashes when it may not have been necessary.
The beginning of the climacteric begins with perimenopause which can start up to 10 years before the final menstrual period. The unique hormonal characteristic of this stage is that it is highly variable from start to finish, from month to month and from year to year. This variability is part of what makes this stage hard to manage. That said, perimenopause is, for the most part, characterized by high estrogen levels and low progesterone levels. Symptoms of this hormonal picture include but are not limited to heavy bleeding, fibroids, irregular cycles, hot flashes, water retention, weight gain, breast swelling and tenderness, sleep disturbance and mood swings. Treatment at this time would be to focus on clearing excess estrogen and providing progesterone enhancement. Central to this treatment is supporting the whole physiology by promoting a well-functioning liver which clears estrogens, free-flowing bile with eliminates excess estrogen, normal bowel moments which ensure estrogen is being removed fully from the body, low histamine activity which if in high amounts can potentiate estrogen. One reason that clearing estrogen is so critical is because high estrogen can impair thyroid function. Many symptoms that appear to be due to perimenopasue are actually due to blocked thyroid hormone activity. A properly functioning thyroid is essential for perimenopause. Most important of all however are healthy adrenal glands which ensure adequate progesterone secretion to counterbalance the excess estrogen.
Menopause lasts one day. It is considered to be one year after the last day of the last menstrual period. That’s the day of menopause. Thereafter, one is considered post-menopausal.
Post-menopause is characterized by low estrogen and low progesterone levels which can start to occur randomly during perimenopause particularly at the end when more anovulatory cycles (no ovulation) take place. Fewer and fewer ovulatory cycles result in less and less estrogen produced by the ovaries. Low estrogen is initially a blessing as previously high levels start to decline and the issues associated with high estrogen resolve themselves. Fibroids resorb and breast tenderness disappears. Instead, as estrogen levels drop, hot flashes, night sweats and insomnia may persist and heart palpitations, vaginal dryness, low mood and difficulty concentrating can begin.
But wait a minute. Given that these hormones are considered the essence of the female biological imperative, how does a woman maintain this hormonal expression after the ovaries no longer make the female hormones? What happens now?
Enter the enzyme aromatase. Nature’s saving grace for continued female hormone expression after menopause. Aromatase has the blessed ability to convert androgen precursor hormones including DHEA (made by the adrenal glands) and testosterone (which naturally increases as a woman ages) into estrogen. In a young girl, hardly any aromatase activity is at work. Aromatase plays an important role during the menstruating years although it can cause issues if it is out of balance: it will cause PCOS if underachieve (more testosterone and less estrogen) or potential breast or uterine cancers if over active (excessive estrogen). At the time of menopause, aromatase is ideally functioning at maximum capacity. Many organs are involved in aromatase activity. The adrenal glands in particular are essential for aromatase expression. If inflammation, high stress, prolonged anxiety or depression, blood sugar imbalances, long-term sleep issues have affected adrenal function, the organ’s ability to utilize aromatase for androgen conversion to estrogen is reduced. Progesterone production by the adrenals could also be impaired. This means that healthy adrenal glands in particular are central to an easeful post-menopausal time.
Menopause is a normal, physiological process that frees a woman from the reproductive encumbrances of her early years. This is a time of new beginnings rather than the start of a decline. Naturopathic medicine is uniquely adapted to supporting the perimenopausal or postmenopausal woman because the central mandate of this medicine is to optimize physiological function. When fundamental organ systems are working optimally, menopause can be relatively seamless. Every woman is unique. Please connect with your naturopathic physician to determine the best approach for you.
Ann Louise Gittleman, PhD, CNS. Before the Change. Harper Colllins 2017.
Hudson, Tori. Women’s Encyclopedia of Natural Medicine: Alternative Therapies and Integrative Medicine for Total Health and Wellness. McGraw Hill 2008.
Weed, Susan. Menopausal Years The Wise Woman Way: Alternative Approaches for Women 30-90. Ash Tree Publishing 1992.
McQuade Crawford, Amanda. The Herbal Menopause Book: Herbs Nutrition and Other Natural Therapies. Crossing Press 2009.