A Note from Dr. Roz: Conscious Communication for Stress
May 28, 2018

Surviving, and Thriving, with Hormonal Changes in Menopause

How do you deal with the changes going on in your body during menopause? Some of them might be uncomfortable, but they do not have to result in a life sentence – they can be treated, and quite easily! Today, we will discuss more about the symptoms, the treatments, and what you can do to “survive the change” on your own terms.

Menopause: Defined

As we age, natural hormone changes occur in our bodies. The medical community defines menopause as the complete cessation of your menstrual period. In order to be classified as achieving menopause, you have to be without a cycle for a full twelve months.

Bottom Line: On average, a healthy woman will have irregular periods for four years before fully reaching menopause.1

The Symptoms

During those four years many of the symptoms associated with menopause begin to appear. The symptoms can be very bothersome and they might include:

    • Irregular periods
    • Hot flashes
    • Poor sleep
    • Vaginal dryness2

Hot flashes are one of the most reported symptoms of perimenopause. Estrogen serves as a temperature regulator at the level of the hypothalamus, and as the estrogen levels begin to wane, the body has difficulty regulating core temperature.

Hot flashes can happen through the day and night, and can be very uncomfortable and even affect sleep patterns3. Sleep disturbances are also caused by drops in the hormone progesterone.

Key Insight: Progesterone has a net calming effect, and many women in perimenopause experience lower levels of it. Additionally, lack of progesterone can cause irregular and heavy periods during perimenopause4.

Estrogen also helps uterine and vaginal lining to proliferate, during perimenopause the natural levels of estrogen decrease making the uterine and vaginal tissue atrophy.

This predisposes perimenopausal women to painful sexual intercourse, uncomfortable vaginal dryness and even recurrent urinary tract infections5.

Bottom Line: The symptoms associated with menopause can have a direct impact on your overall quality of life, as well as your health. Thankfully, there are many options to prevent all of these symptoms.

Lifestyle Factors

Other factors that affect “hot flashes” are consumption of caffeine and refined sugar consumption.

A study published on “Menopause: The Journal of The North American Menopause Society” found that consumption of caffeine increases the incidence of vasomotor symptoms in women6.

Key Insight: Caffeine is processed in the liver, and thus, it affects the way the body clears sex hormones leading to undesirable levels of sex hormones7.

Insulin resistance seems to associated with hot flashes too. In a study by Thurston and friends found that insulin resistance was associated with higher incidence of vasomotor symptoms independent of BMI or sex hormone levels8.

This is important because even if you are years away from reaching perimenopause you can start working on preventing future symptoms.

How do you ensure that you can prevent future symptoms? Here are some simple steps:

  1. Ensure you have good insulin sensitivity
  2. Avoid processed foods that spike your blood glucose levels
  3. Include resistant starch in your diet, it helps modulate your insulin response

Bottom Line: By following those simple suggestions, you can help reduce hot flashes or even prevent them before you reach perimenopause altogether.

Natural Hormone Replacement Therapy

There is much conflicting information on the use of hormone replacement therapy for the amelioration of perimenopausal symptoms.

Estrogen replacement therapy has been used for the resolution of symptoms like hot flashes and osteopenia, and in 2002, a study published on the Journal of the American Medical Association suggested that the use of hormone replacement therapy increased the risk of cardiovascular event and cancer9.

After the publication of this “landmark” study, about half of the women partaking in hormone replacement stopped using this intervention.

Unfortunately, the results were overblown. There were a couple of reasons why the claims on this study are erroneous. First, it only took into consideration women taking oral replacement hormones. This is very important, because the liver is in charge of processing oral estrogens.

These compounds are hard to conjugate and make the liver work harder. In turn, the liver makes more coagulation proteins and increasing the risk of cardiac problems. This is not the case when a patient uses injections or creams. These hormones bypass the liver, avoiding this problem.

The increased cancer risk was linked to the fact that breast tumors seem to have an affinity to estrogen molecules. But a later study found that the use of physiological doses of testosterone actually decreases risk10.

Your body naturally converts excess testosterone into the necessary levels of estrogen needed for normal physiological function. Not too little, not too much.

Additionally, increased testosterone levels are associated with:

  • Decreased cardiac disease
  • Stronger bones
  • Increased muscle mass
  • Increased libido!11

These are some of the key points that you should also keep in mind:

  • Avoid the use of oral hormone replacement therapy
  • Ask your doctor about balancing your hormones to natural levels (not too much, not too little)
  • Use testosterone replacement responsibly, and allow your body to convert to estrogen-only to the levels that are needed

Discovering The Treatments

A meta-analysis comparing the effects of acupuncture on hot flashes determined that acupuncture reduced frequency, severity and symptoms of hot flashes and thus improved overall quality of life.

Acupuncture is a Chinese traditional medicine modality that uses fine needles to treat the entire body. Acupuncture treatments can be compounded to treat various symptoms, not just hot flashes, your practitioner can even treat symptoms like:

  • Depression
  • Insomnia
  • Stress12

Low progesterone levels can be corrected with the use of micronized progesterone capsules. In addition to correcting hormonal levels, oral progesterone binds to GABA receptors, the “chill receptors” in your brain, and it facilitates sleep without causing dependence.

Key Insight: If you are not comfortable taking progesterone orally, a low dose progesterone cream can help normalize your progesterone levels, but it may not be as effective in correcting the sleep disturbances13.

Vaginal dryness can be easily corrected with DHEA-hydrating vaginal creams. DHEA is a precursor to other sex hormones like testosterone and estrogen. DHEA helps reverse vaginal dryness and helps maintain the vaginal flora and thus reduce the risk for painful intercourse and recurrent urinary tract infections. A great product we often recommend is Julva Cream, it is a synergistic blend of DHEA and botanicals that helps reverse that annoying symptom.

One of the advantages of DHEA vaginal creams is that they don’t affect blood levels of DHEA and thus have less incidence of side effects like undesired hair growth14.

Bottom Line: Treatments like acupuncture, micronized progesterone capsules, and DHEA-hydrating vaginal creams paint a clearer picture of how we can deal with the symptoms caused by menopause. Not only that, but they paint a brighter picture for our health and happiness moving forward!

Embrace Change, Survive Change

As you can see, going through the change does not have to affect your overall quality of life. Working with your doctor at Integrative Health can help ensure an easy transition to make the next stage of your life fulfilling and full of health.

Dr. Guillermo Ruiz NMD graduated from the Southwest College of Naturopathic Medicine. Prior to his doctorate, Dr. Ruiz spent his childhood in Mexico, before moving to Florida in 1996. Dr. Ruiz finished a Bachelor of Science Degree in Medical Sciences and a minor in Health Services Administration at the University of Central Florida.

While pursuing his bachelor’s degree he worked at Arnold Palmer Hospital for Children. As an Advanced Clinical Tech, he worked under an incredible team of doctors and nurses in the Pediatric Emergency Department and Level One Trauma Center. He witnessed the amazing, state-of-the-art care in emergency medicine but also learned of a larger health care system in disarray. He used this new perspective and a passion for evidence-based medicine to change his life. By changing his diet, learning about proper movement and implementing optimal lifestyle habits he was able to improve his personal health and find a calling in Naturopathic Medicine. At that point he decided to further his career with a focus on finding and removing the underlying obstacles to health.

While attending SCNM, Dr. Ruiz became interested in the treatment of endocrine disease with a focus on thyroid health. Under the mentorship of Dr. Alan Christianson, Dr. Ruiz expanded his knowledge on the treatment of Hashimoto’s and Grave’s disease and has completed advanced endocrinology training in order to better address and resolve endocrine disease.

Dr. Ruiz has a deep love for botanical medicine and has presented nationally and internationally on to the topic. He currently holds a position as a research assistant at SCNM and works part-time as a researcher at the Arizona State University Biodesign Institute. His research focuses in the prevention, control and treatment of multidrug resistant bacteria and viruses with the use of botanicals and other naturally occurring substances such as amino acids and minerals.

In his spare time, Dr. Ruiz hosts his own podcast “30/30 Health” where he interviews the most influential personalities in the health movement. Dr. Ruiz strives to advance naturopathic practices with an evidence-based medicine approach.

1 – Taffe JR, Dennerstein L. Menstrual patterns leading to the final menstrual period. Menopause 2002; 9:32.McKinlay SM, Brambilla DJ, Posner JG. The normal menopause transition. Maturitas 1992; 14:103.
2 – Taffe JR, Dennerstein L. Menstrual patterns leading to the final menstrual period. Menopause 2002; 9:32.McKinlay SM, Brambilla DJ, Posner JG. The normal menopause transition. Maturitas 1992; 14:103.
3 – Gold EB, Colvin A, Avis N, et al. Longitudinal analysis of the association between vasomotor symptoms and race/ethnicity across the menopausal transition: study of women’s health across the nation. Am J Public Health 2006; 96:1226.
4 – Hollander LE, Freeman EW, Sammel MD, et al. Sleep quality, estradiol levels, and behavioral factors in late reproductive age women. Obstet Gynecol 2001; 98:391.
5 – Gandhi J, Chen A, Dagur G, et al. Genitourinary syndrome of menopause: an overview of clinical manifestations, pathophysiology, etiology, evaluation, and management. Am J Obstet Gynecol. 2016;215(6):704-711. doi:10.1016/j.ajog.2016.07.045.
6 – Faubion SS, Sood R, Thielen JM, Shuster LT. Caffeine and menopausal symptoms: What is the association? Menopause. 2015;22(2):155-158. doi:10.1097/GME.0000000000000301.
7 – Kotsopoulos J, Eliassen AH, Missmer SA, Hankinson SE, Tworoger SS. Relationship Between Caffeine Intake and Plasma Sex Hormone Concentrations in Premenopausal and Postmenopausal Women. doi:10.1002/cncr.24328.
8 – Thurston RC, Khoudary SR El, Sutton-Tyrrell K, et al. Vasomotor Symptoms and Insulin Resistance in the Study of Women’s Health Across the Nation. doi:10.1210/jc.2012-1410.
9 – Writing Group for the Women’s Health Initiative Investigators WG for the WHI. Risks and Benefits of Estrogen Plus Progestin in Healthy Postmenopausal Women: Principal Results From the Women’s Health Initiative Randomized Controlled Trial. JAMA J Am Med Assoc. 2002;288(3):321-333. doi:10.1001/jama.288.3.321.
10 – Glaser RL, Dimitrakakis C. Reduced breast cancer incidence in women treated with subcutaneous testosterone, or testosterone with anastrozole: a prospective, observational study. Maturitas. 2013;76(4):342-349. doi:10.1016/j.maturitas.2013.08.002.
11 – Morley JE, Perry HM. Androgens and Women at the Menopause and Beyond. Journals Gerontol Ser A Biol Sci Med Sci. 2003;58(5):M409-M416. doi:10.1093/gerona/58.5.M409.
12 – Y, Pan C-H, Shyu Y-K, Han B-C, Tsai P-S. Effects of acupuncture on menopause-related symptoms and quality of life in women in natural menopause. Menopause. 2015;22(2):234-244. doi:10.1097/GME.0000000000000260.
13 – Prior JC. Progesterone for Symptomatic Perimenopause Treatment – Progesterone politics, physiology and potential for perimenopause. Facts, views Vis ObGyn. 2011;3(2):109-120. http://www.ncbi.nlm.nih.gov/pubmed/24753856. Accessed May 22, 2018.
14 – Y, Pan C-H, Shyu Y-K, Han B-C, Tsai P-S. Effects of acupuncture on menopause-related symptoms and quality of life in women in natural menopause. Menopause. 2015;22(2):234-244. doi:10.1097/GME.0000000000000260.

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