From Menarche to Menopause

Schroeder_Elise_webDr. Elise Schroeder Lectures at Women’s Health Day NCNM Clinic

From Menarche to Menopause: Definitions

Adrenarche – Adrenarche happens between ages six and nine and is the start of puberty. During this time, the hormone DHEA, which is a precursor to estrogen and testosterone, is produced in increasingly large amounts. This triggers the beginning of puberty.

The menstrual cycle – Day one is the first day of bleeding. On this day all hormones are very low (start of follicular phase). Estrogen begins to rise the first week and then peaks at ovulation, generally day 14.  After ovulation (luteal phase), progesterone begins to rise, which prepares the uterine lining for implantation. If the egg is not fertilized within that week, both progesterone and estrogen will start to fall and a week later (day 28) bleeding will start. If this hormone cycle is out-of-balance in young women, symptoms can occur such as: moodiness, acne, PCOS, irregular periods, heavy bleeding, and endometriosis.

Perimenopause – Can begin as early as the mid-thirties, as first progesterone and then estrogen produced by the ovaries starts to decline. This decline will interrupt ovulation which can cause irregular periods and many menopausal symptoms and this is known as perimenopause. Symptoms include: lack of sleep, night sweats, bloating, depression or anxiety, weight gain, hair loss, skin and vaginal dryness.

Menopause – Menstrual cycles may get closer together or more spread apart until they go away completely. After 12 consecutive months without a cycle a woman is officially in menopause. The average age of menopause onset is 52 years.  There is no way to predict how long symptoms will last; each woman is different and it varies widely.

What are hormones?

Hormones are chemical messengers for every cell in our body. Examples of hormones are estrogen, progesterone, testosterone, cortisol and thyroid.

Estrogen: contributes to the growth of ovarian follicles, uterine lining, and breast tissue during pregnancy and lactation. It also contributes to brain health, mood stability, and vaginal secretions. The ovaries, adrenal gland, fat, liver, and breasts produce estrogen. You can also be exposed to external estrogens through the environment (ex. plastics), diet (plant estrogens), and drug therapy.

Premarin vs. bioidentical estrogen –  Premarin is known as ‘conjugated equine estrogens’ and is isolated from a pregnant mare’s urine.  It is similar, but not identical, to the estrogens that humans produce. Bioidentical estrogen is chemically identical to the human hormone. Premarin was the hormone studied in the Women’s Health Initiative. There is some research on bioidentical estrogens, more is warranted. A recent study published by Stanford medical school in March 2014 found that bioidentical estrogen, but not Premarin, preserves key brain regions in postmenopausal women at risk for dementia.

Progesterone: Maintaining a pregnancy is the most recognized action of progesterone. However, it also relaxes the nervous system, increases core temperature, enhances anti-inflammatory effects, increases use of fat for energy, and regulates the signaling of insulin release.

Progesterone vs. progestin: Progestin is a synthetically produced progestogen that has similar effects to progesterone, yet is much stronger. It is the hormone used in birth control pills and also the hormone that was studied in hormone replacement in the Women’s Health Initiative. Progestin does not affect the brain like progesterone does; this means all the beneficial effects of progesterone on the brain are not seen with progestin.  In addition, progestin has been shown to have harmful effects on the cardiovascular system. Bioidentical hormone replacement uses progesterone and not progestin.

Testosterone: Women produce testosterone in the ovaries and as a hormone derivative of DHEA from the adrenal gland. Testosterone is further converted into estrogen, and DHEA is a building block to testosterone and estrogen. Testosterone plays a role in bone health, as well as in building lean muscle and strength. It is best known for its role in a woman’s sex drive or libido.

Cortisol: Also known as the ‘stress’ hormone. When stressed our adrenals glands release cortisol to help us adapt to the stress. This hormone will increase glucose into the bloodstream, alter immune function, and depress the digestive system. This hormone is good for short term fight-or-flight situations, but when chronically stimulated can cause numerous health problems.

Adrenal fatigue is a common result of chronic stress. Common symptoms include feeling tired-but-wired, afternoon fatigue, difficulty making decisions, and allergies.

Thyroid: Produced from the thyroid gland that sits at the lower front of your neck, thyroid hormone is essential for maintaining metabolism and energy. It must also be balanced with cortisol. When cortisol is running high it can blunt thyroid production. Some symptoms of decreasing thyroid hormone are cold hands and feet, hair loss, dry skin, constipation, fatigue, and poor concentration.

Common Questions and Answers

Q: I am very ill-informed about soy. Is it the same as estrogen?

Soy is a phytoestrogen (phyto means plant). It is not exactly like estrogen, but it is similar. The recent large quantity of soy consumption over 10 years ago caused some concern and called for increased studies. There are issues with soy because it is a prominently genetically modified crop and it is often highly processed. To find out the most up-to-date information on soy consumption please read What’s the  Soy Story.   If you are going to consume soy,  it is best to choose  fermented organic whole soy products like tempeh, miso, and natto.

Q: I am using a hormone replacement therapy. Should I still get my hormones measured?

Measuring hormone levels periodically is important once using HRT. If you are feeling great, once yearly might be enough. However, if your symptoms are changing it is important to check your levels right away. Many doctors will also perform a test to determine how well your body metabolizes the hormones. This is separate from monitoring hormone levels but also very important to your overall health.

Q: How are hormones measured?

Measuring hormones is usually done by testing the saliva, which reflects how much hormones are in body tissues at that particular time of testing. However, depending on the individual, saliva, blood, or urine can be used.

Q: When is the best time to test my hormones?

Female hormones fluctuate quite a bit throughout the month, so it is important to measure the hormones at a certain time period in the cycle to get the most accurate reading.  Usually days 19-21 of the menstrual cycle are the days to test.  However, it also depends on what types of hormones are being tested and every woman is different; your doctor will know the best time to test your hormones.

Q: If you were on the birth control pill for a very long time and then stop completely, do your hormones recover?

Some women in menopause do not see a drop off of hormones as much as younger women. It depends on what stage of life you are in.

Q: Do women who went through surgical hysterectomy have a different experience with menopause then those who did not?

Surgery could include a total hysterectomy where both ovaries are removed along with the uterus or partial hysterectomy where the ovaries are kept intact. This will make a difference since the ovaries make the bulk of the hormones. When ovaries are removed, women will be tested for hormone levels and  put on hormone replacement therapy. Once women reach menopausal age, around 51, they will start to decrease hormone dosage and soon enter menopause. Their experiences with menopause are usually the same as those who didn’t have surgery- as long as the hormones are balanced. Testing is important, as is paying attention to symptoms that may arise.

There are also women who still have their ovaries and who experience symptoms of hormone decline following the removal of the uterus. It is not uncommon to benefit from hormone replacement in these cases. Blood flow to the ovaries may have been affected by the surgery.

Q: I went through menopause, and I thought I was done. Why am I still experiencing symptoms? Does this mean that I’m not done with menopause, or is there a hormone imbalance?

Menopause can last from a couple years to up to 15 years. Each woman is unique in how she will respond to decreased hormones. Some more common symptoms that can last for longer periods are lack of sleep and irritability. There are many natural therapies that can be used besides hormone replacement to help women with ongoing symptoms of menopause. To find out more about therapies for your individual situation it is best to talk to your naturopathic doctor.

Q: I have a chronic bladder infection. Is that due to a hormone imbalance?

When hormones drop, the tissue integrity of the vagina and the bladder are weakened, and this can cause infections or chronic pain. Balancing hormones can increase the tissue lining integrity, leading to increased lubrication and decreased infections. In addition, chronic bladder infections can be caused by factors such as food sensitivity, high carbohydrate diet, and gut microbiome imbalance.

red_raspberry1Women’s Herbal Iced Tea

  • Put one heaping tablespoon each of dry herbs: red raspberry leaf, nettle, dandelion leaf, mint and fennel in a jar.
  • Add to 4 cups of boiling water.
  • Brew for 10 minutes and then cool in fridge.
  • Pour through a strainer and discard or compost the herbs. Add ice and enjoy! Can drink 2-4 cups daily.

Other great hormone balancing herbs: black cohosh, wild yam, maca, vitex, ashwaganda, and shatavari. Talk to your doctor. Dose depends on you!

Written by: Haylee Nye NCNM Naturopathic Medicine program  edited by Dr Elise Schroeder