Getting a Grip on Menopause

Getting a Grip on Menopause : Menopause is an inevitable part of life that can become an existential crisis for 85% of menopausal women in United States who also experience significant symptoms like hot flashes, mood changes, cognitive impairment, reduced sex drive, weight gain, insomnia, fatigue, skin and hair issues, and are long term at increased risk for osteoporosis and heart disease.

Some of these can last upward of a decade.

Clearly, these seemingly sudden changes can be stressful. Having a last menstruation 12 months ago is the milestone for menopause, albeit one arbitrarily set. In fact menopause develops over years, through ovarian aging and declining hormone production impacting organs and systems over the entire body. Although these hormones are essential for fertility, they also are critical in normal functioning of the immune system, brain, cardiovascular and digestive systems, metabolism, muscle and bone. But what if women could feel better prepared, less anxious, and more in control when menopause hits? With proper awareness and self care, we can compensate for the challenges our bodies may face at menopause and enjoy excellent health to old age.

A Condensed Biology Lesson

As women enter their 40s, their ovaries tend to produce fluctuating levels of estrogen. This production decreases until they no longer menstruate. At some, point their ovaries “retire” — they cease to produce sex hormones and the adrenal glands, who also produce cortisol and DHEA amongst other hormones, take over. As we mentioned earlier, once 12 months have passed since their last period, they’ve officially reached menopause.

Cortisol is well known as the body’s stress hormone, but its reach is far greater. In fact, that’s only about 5% of what it does. It is the main biomarker for a wide range of bodily functions and a key inhibitor of estrogen and progesterone production at multiple levels..

Any time a woman experiences fluctuations of estrogen, her body perceives it as stressful, causing the adrenal glands to overproduce cortisol. That in turn, supresses the sex releasing hormones (GnRH, FSH and LH) pushing he body to make even less of the estrogen and progesterone it needs to stay in balance. That’s menopause in a nutshell: estrogen and progesterone vary and get out of balance with each other, then drop. Depending on your lifestyle, cortisol goes haywire making everything much worse and leaves the adrenal glands unable to take over some of the missing ovarian function. But if women can sustain optimal cortisol levels, it could shape just how well the transitional period goes for them.

There are four main hormones to watch during menopause:

Estrogens

When we think about menopause, we typically think first about estrogen, the sex hormones that regulates the menstrual cycle and have a protective and effect on the cardiovascular system, bone and brain amongst others. Estrogen receptors are distributed in greater or lesser quantity in various tissues according to your genetic heritage, so your symptoms may differ. When estrogen levels drop, usually around the age of 45, this signals perimenopause (the start of the transition to menopause). However, estrogen isn’t simply dwindling during this time. It’s rising and falling like a rollercoaster, right up until it plummets.

As a result of increased in life expectancy, many women will spend the second half of their lives with an estrogen deficiency leading to frailty and disability at old age. Estrogen deficiencies have been linked to degenerative diseases of the cardiovascular, skeletal(muscle, bone and connective tissue) and central nervous systems, as well as metabolic dysfunction, which can lead to obesity, metabolic syndrome, type 2 diabetes, dyslipidemia and even breast, colon, and liver cancer.
Progesterone

Before menopause, women are typically adept at buffering stress because progesterone — often called the “feel good” hormone and the pregnancy hormone — and dehydroepiandrosterone (DHEA) were produced along with cortisol, balancing out cortisol’s effects. However, once women enter perimenopause, their progesterone levels often decrease, and they have less of a stress buffer. Once menstruation ceases, the ovaries stop producing progesterone. Women with higher levels of progesterone during perimenopause may experience significantly higher life satisfaction, lower perceived stress, and lower depressive symptoms than women with lower levels.
Testosterone

Both men and women produce testosterone in different parts of the body. But this crucial hormone decreases over time, with significant effects on each gender, including decreased sex drive and muscle strength, and increased depressive symptoms, fatigue, and sleep issues.
Cortisol

Here’s the thing to understand about cortisol … it’s not just the main stress hormone with the loudest voice in the hormonal orchestra. It also regulates your sleep-wake cycle, blood sugar levels, energy metabolism, blood pressure, and more. When at optimal levels, it’s quietly working behind the scenes along with a score of other hormones, ensuring you’re operating at top form. That’s why it’s critical to balance cortisol levels throughout our lives and especially during pre-menopause and menopause when we loose the protection of estrogen and progesterone.

The Cortisol Connection

Before menopause, women’s bodies are more likely to have optimal levels of progesterone and estrogen, providing excellent stress buffers. But as bodies age and hormonal levels start to go haywire during perimenopause, women have less cushion against stress and high cortisol. Thus, it’s no wonder that menopause symptoms echo many of those seen in cortisol imbalances, including:

Weight gain
Hot flashes
Cravings for unhealthy foods (sugar, fat and salt)
Insomnia and other sleep issues
Low energy
Low sex drive
More aches and pains
Mood changes and depression
Skin and hair issues

The good news is you can reduce many menopause symptoms by balancing first your cortisol levels. Menopause and aging happen together, but the results of hormonal imbalances are not inevitable.

5 Ways to Regain Control

The first step to taking back control is understanding what’s happening in your body and trying to get ahead of emerging issues. Here are five ways to do that:

Measure your cortisol pattern, which you can soon do easily from home. To appreciate the powerful role cortisol plays, you need a nuanced, comprehensive picture of its behavior throughout the day via real-time tracking measurements, which is why traditional at-home or lab tests do not suffice. Finally, there is a simple way to read your daily cortisol rhythms via an app in your mobile phone.
Change your mindset by acknowledging and managing stress.
Stay active in the right way. Menopause can decrease bone density and muscle mass, and increase body, especially belly (around your organs) fat. Higher muscle mass is associated with a higher metabolic rate, increased cognitive performance and protection from frailty and falls. Engage in weight lifting exercise two or three times a week to build and maintain muscle and bone. Caveat, at menopause too much exercise (too prolonged, too frequent or too strenuous) can cause a deleterious increase in cortisol that is counterproductive, leading to muscle loss and resistance to weight loss.
Incorporate adequate protein into your meals, as we age we need more of it . Getting adequate amounts of protein (1-1.5 grams of protein per kilogram of body weight) and consuming it throughout the day and after exercise, helps to build and preserve muscle. For example, an active menopausal 150 lb woman should consume 25-35 grams of protein at each of her 3 meals. Remember to also incorporate nutritious whole foods, mainly from plant-based sources, fiber, healthy fats, as well as herbs and spices rich in polyphenols, and fermented foods as tolerated.
Many women are prescribed antidepressants and anti-anxiety drugs instead of being told about the realities of hormonal changes and the best ways to mitigate them. If indicated, investigate bioidentical hormone replacement therapy (BHRT) with a knowledgeable healthcare professional. If implemented, it should be done as soon as possible after reaching menopause as the risk-benefit ratio becomes less favorable after 10 years. “Bioidentical” means that the hormones used are chemically identical to the ones your body produces.

For the 24 million women who are suffering from debilitating menopausal symptoms and just want to feel like their vibrant selves again, properly managing cortisol levels can make the difference between feeling great or suffering through challenging midlife changes, and between their hormone replacement regimen working optimally or not

Author:

Ioana A. Bina, M.D., Ph.D., is a fellow of the American College of Gastroenterology and a member of the Institute for Functional Medicine. She holds her M.D. and a Ph.D. in endocrinology from Carol Davila University in Bucharest, Romania, and completed her internal medicine, gastroenterology, and nutrition fellowship training at Yale University. She undertook advanced studies in endocrinology, metabolism, and nutrition at Rouen University in France. She serves on the Scientific Advisory Board of Paradigm, Inc. She is the co-author of Cortisol: The Master Hormone. Learn more at Pardigm.com.