Menopause and Hormones

HELP FOR THE MENOPAUSEWHAT EVERY WOMAN OUGHT TO KNOW 

Not so long ago “The Change” was a taboo subject. Your Doctor suggested that you put up with it and your family tolerated your erratic moods with a mixture of embarrassment and bewilderment. The menopause and its seemingly inevitable catalogue of unpleasant symptoms wasn’t something that you talked openly about with your friends either. Thankfully, these days there is a lot less secrecy and mystery surrounding the menopause.  But there is still quite a lot of information that you may not be aware of.

Menopause in its literal sense means the last menses or period. It is defined medically as not having had a period for a year. A woman will not actually know she has had the menopause until a year after her last period.  The medical term for what is commonly referred to as the menopause, is in actual fact the peri‐menopause, a phase which can last 10 years or more, in which the hormones are fluctuating and symptoms are occurring.

Hormonal Mayhem

During the peri‐menopause, oestrogen production decreases which produces a corresponding drop in progesterone. Periods can stop suddenly, become heavier or lighter or the cycle can shorten or lengthen. The levels of FSH will keep increasing in order to try and stimulate the ovaries to produce oestrogen.

The main symptoms that can be experienced are hot flushes, insomnia, weight gain, reduced libido, mood swings, loss of bone density, vaginal dryness, loss of skin elasticity and tone, dry eyes, headaches and fatigue.

The commonly promoted belief is that the above symptoms are the result of reduced oestrogen levels. If this were true, every woman going through the menopause would experience symptoms but this is not actually the case.

Is The Menopause An Ilness?

No, it is definitely not an illness! There is however still a view adopted by some people that it is a disease rather than a natural event. Way back in 1966 Robert O. Wilson, MD published what became a best selling book, Feminine Forever. He wrote “Many physicians simply refuse to recognize menopause for what it is – a serious, painful, and often crippling disease.”

He was an ardent promoter of HRT (hormone replacement therapy now more often known as HT or hormone therapy) and his influential writing reinforced the idea that menopause is a disease that needs to be “cured” by supplying hormones. Women were prescribed HRT in their millions. Then in the 90s HRT lost its reputation as a panacea for menopausal symptoms when trials had to be halted as it was found that the women taking the hormones were more likely to suffer strokes, heart disease and breast cancer. Other reported side effects are hair loss, depression and weight gain. Nowadays GPs are more reluctant to prescribe HT although there are still a large number of women currently taking it. Faced with uncomfortable symptoms it’s understandable that some women choose what seems like an easy option, hormone tablets, patches or gels.

What is the Alternative to HRT?

However, you may have weighed up the risks and decided you want an alternative.  A useful starting point is to look at the menopause as a natural transition rather than a deficiency disease. The hormonal flux of the menopause is inevitable but symptoms are not. The focus then shifts to strengthening the body both physically and mentally to build up resilience to the changes taking place in the body.

Diet and nutrition play a very important role in creating this resilience. Blood sugar balance, less than optimal levels of specific vitamin and minerals, antioxidant status, gut health and food intolerances, inflammation, sub optimal functioning of the adrenal and thyroid glands and being over or underweight can all disrupt hormone balance and are factors to consider and manage.

See my article Menopause Help – 8 Ways to Thrive on the home page of this website in the articles section, for nutrition tips. Book a nutrition consultation with me and receive a personalised programme to address your specific needs.

Balancing Hormones Naturally

The hormonal orchestra

Hormone” means in Greek, “to set in motion.” Hormones are chemical communicators produced by glands and tissues. They are released into the blood where they travel to other tissues, sending signals and initiating various activities in the body and brain. Hormones affect how we think and feel and keeping them in balance will profoundly affect our health and wellbeing.

Maintaining the correct levels of hormones is a complex and delicate balancing act taking place continuously in our bodies. Many factors affect hormone production and even slight imbalances (which may not show up in conventional hormone tests) can cause symptoms. Conditions involving hormone imbalance include pre‐menstrual syndrome, an irregular cycle, lack of periods, menstrual pain, PCOS, endometriosis, infertility, abnormal cells on the cervix, premature bone loss, fibroids, inability to lose weight, auto immune diseases, poor circulation, digestive problems, dry eyes and skin, insulin resistance and diabetes.

The hormonal orchestra

The sex hormones, oestrogen, progesterone and testosterone are probably the most well know hormones and they control sexual development and reproduction. Other examples are the thyroid hormones that are responsible for growth and metabolism, stress hormones such as adrenaline and cortisol from the adrenals and blood sugar balancing hormones such as insulin made by the pancreas.

The various different hormone (endocrine) glands work in an interconnected way, rather like an orchestra. The conductor of the hormonal orchestra is the pituitary gland in the brain. Each gland needs to be in tune with the others and if one becomes over or underactive it will upset the balance of the others.

Blood sugar balance

One very direct way in which nutrition influences hormone balance is through blood sugar control. Insulin is the principle blood sugar balancing hormone and it can become less efficient if constantly stimulated by a diet high in refined sugar. This can have a knock‐on effect on the rest of the hormonal system. Women suffering from the hormonal disorder Polycystic Ovary Syndrome, understand the connection well as they can get very severe cravings for sweet foods. The drug metformin is often prescribed in these cases as it treats the blood sugar imbalance. However, following the right diet is a highly effective means of keeping your blood sugar balanced. By doing this you will benefit your entire hormonal system.

Oestrogen Dominance

Whilst in the menopausal phase, oestrogen is on the wane, too much oestrogen in relation to progesterone may be a problem during a woman’s reproductive years. This can be because there is actually too high a level of oestrogen or it can be the result of progesterone being too low which means the ratio is imbalanced. Some factors to consider are:

  • Being overweight: Oestrogen is produced by fat cells so it will increase in proportion to body fat. Aromatase is the enzyme in fat tissue that triggers oestrogen production.
  • Inflammation stimulates oestrogen production. Oestrogen is pro‐ inflammatory when there is too much of it so the cycle continues. This activity can be taking place in the ovaries, breast and joints which act as local oestrogen factories.
  • Insulin resistance caused by a diet high in refined sugar creates increased oestrogen production.
  • An unhealthy liver: Poor oestrogen metabolism is a major contributor to oestrogen dominance. Oestrogen has to be broken down by the liver which must be kept in good health. The conventional liver test available via your doctor, checks for abnormalities in certain liver enzymes and other substances. More often than not however, such a test will show normal results unless there is advanced damage in the liver. The right nutrition can be very supportive to healthy liver function.
  • Folic acid deficiency: Methylation is the principle way in which oestrogen is deactivated and for this process, folic acid is essential. It is thought that as many as 30 % of women have a functional folic acid deficiency. 
  • Unhealthy gut flora: Oestrogen may be reabsorbed into the gut leading to too much of it. After being broken down by the liver, oestrogen leaves the body through the stool. Unhealthy gut bacteria produce an enzyme, Beta glucuronidase which will interrupt the process by reactivating the oestrogen in the bile, so that it is then released as free oestrogen and is reabsorbed into the bowel. Production of this enzyme will be increased by a diet high in saturated fat.
  • Poor digestion leads to inefficient excretion of oestrogen metabolites.
  • Stress if prolonged over a period of time, will disrupt hormone balance.

So as you can see, achieving optimal hormone balance requires a multi faceted approach. All the above factors are amenable to nutritional interventions.

Synthetic oestrogens

As well as putting the good stuff into your body, it’s important to be aware of potentially negative substances in the environment. In the last 50 years a huge number of synthetic chemicals have been introduced into the environment. For example vehicle pollution, plastics, pesticides, industrial waste, household cleaning fluids and carpeting are just a few sources. These environmental chemicals contain xenooestrogens which are very disruptive to hormone health. A rather alarming illustration of this is that some fish from polluted water have been found to have both male and female sex organs.

Such “foreign” oestrogens mimic the action of regular oestrogen and are taken up by the oestrogen receptors in the cells, causing the formation of cysts and the development of disease. The positive news is that dietary factors will influence the balance of “good” and “bad” oestrogens in the body.

Saliva hormone testing

Oestrogen has to be very carefully balanced and managed in the body. The tiniest increase in oestrogen can have a significant effect. Excess oestrogen in women is associated with conditions such as endometriosis, fibroids, fibrocystic breasts and cervical dysplasia (abnormal cell growth on the cervix). In men, too much oestrogen can lower sperm count.

A standard hormone test via your GP will involve measuring levels of bound sex hormones such as testosterone, oestrogen and progesterone, in the blood. Unless a hormone imbalance is pronounced, the results of such a test will often come back normal. Much hormone imbalance is more subtle than this and is outside the scope of a blood test. A more sensitive means of testing is to use saliva which measures free circulating hormones rather than bound ones. Multiple samples can be taken at different times of the day and month. This makes it possible to track the hormonal pattern over an entire cycle rather than simply spot checking on a certain day as is the case with conventional blood tests. The accuracy of saliva testing is well documented by specialists in the field of steroid hormones (see footnote) but it is not used by the NHS currently. You can have these tests done privately through a nutritional therapist.

Polycystic ovary syndrome

Many women who consult me have Polycystic Ovary Syndrome (PCOS) a condition which is caused by a hormonal imbalance. It is characterized by a cluster of cysts on the ovaries. These cysts are thought to be partially developed follicles which fail to mature enough to produce an egg.

Maureen’s story

Take my client Maureen for example. She had been diagnosed with PCOS at age 32, after not having a period for eight months. When she came to see me, progesterone from her GP had kick‐started her cycle again but it was irregular and she was suffering from painful periods. She also had other typical symptoms associated with PCOS such as abdominal bloating, cravings for sweet foods, skin problems and frequent mood swings. She had also been told by her specialist that she had a less than 10 percent chance of conceiving naturally and had been advised to do assisted fertility treatment.

Since Maureen had a history of sever constipation, my first priority was to improve her bowel function because the accumulation of waste products in a sluggish bowel can affect the reproductive area. We also worked on hormone balance with a blend of herbs including agnus castus. This herb is believed to stimulate the production of luteinizing hormone which in turn regulates the production of progesterone.

When Maureen came to see me a few weeks later, she reported increased frequency of bowel function and a corresponding improvement in the texture and appearance of her skin. According to naturopathic medicine, the two are often connected. The bloating was much better too and her sugar cravings were under control.

Six weeks later Maureen informed me that she and her partner had been to the fertility clinic and had been told that their chances of a natural conception were less than 10 percent.

Maureen decided to continue with the diet anyway as she had got used to it by now but decided that she would also look into assisted fertility treatment. In fact she never needed it as, two months later she called me, delighted to report that she had conceived naturally. The story doesn’t end there either! After giving birth to healthy twins, she fell pregnant again very soon afterwards and had another healthy baby.

These case studies show success with individuals clients. It is important to remember that we are all unique and an individually tailored eating and supplement programme is recommended to ensure an effective outcome.

Premenstrual syndrome (PMS)

Back in 1981 a woman killed her boyfriend after an argument by running him over with her car. The woman was given a conditional discharge for 12 months and banned from driving for the same period. The reason for the light sentence was that the verdict was diminished responsibility due to PMS (pre‐menstrual syndrome).

This is an extreme example of the effects of PMS. However, many women experience monthly mental and physical symptoms ranging from mild to life disrupting. Some of the common ones include:

  • Abdominal bloating
  • Excess gas
  • Wind pains
  • Constipation
  • Irritability
  • Depression
  • Weepiness
  • Clumsiness
  • Poor concentration
  • Feeling “spaced out”
  • Weight gain
  • Headaches
  • Food cravings especially for sweet foods

To be classified as PMS the symptoms must occur after ovulation (i.e. the middle of the month) and disappear around the time your period starts. Recording your symptoms in a diary can be helpful. If the symptoms occur throughout the whole month then PMS is unlikely to be the cause.

There has been quite a lot of research into the cause of PMS, so far without any conclusive results. Most of the conventional treatments on offer consist of giving drugs such as synthetic hormones, diuretics or anti‐depressants. None of these treatments addresses the underlying cause of PMS and they have side effects.

The nutritional approach is to maximise nutrient intake by following the right eating plan, especially paying attention to balancing blood sugar levels, and use additional supplements of herbs or nutrients to correct any deficiencies and imbalances.

A client of mine, Karen, complained of abdominal bloating, severe mood swings, sugar cravings and pain and spotting before the start of her period. All the symptoms except for the bloating would disappear as soon as her period started. We changed her diet quite radically and she took mineral supplements, an active form of B6 and a herbal blend containing herbs to balance her progesterone levels. After 6 weeks her symptoms were much reduced and after 12 weeks, virtually gone. Her reason for consulting me was infertility and once the PMS was sorted out she did go on to conceive 6 months later.

These case studies show success with individuals clients. It is important to remember that we are all unique and an individually tailored eating and supplement programme is recommended to ensure an effective outcome.

Copyright © Penny Crowther (London Nutritionist)
Tel: 07761 768 754 | Email: penny@nutritionistlondon.co.uk

Footnote: Riad‐Fahamy D, Read GF, Walker RF. Salivary steroid assays for assessing variation in endocrine activity. J Steroid Biochem. Jul:19 (1A):265–72. 1983.