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Learn more about Menopause

Menopause can be a difficult transition in a woman’s life
Menopause usually occurs between ages 48 and 52. The onset of hot flashes, extreme mood swings, insomnia, hair loss, uncontrollable weight gain, skin changes, vaginal dryness, decreased sex drive, the fear of osteoporosis, breast cancer, and heart disease all are a part of American women’s experience.

Menopause is a normal transition experienced by women
Women are transitioning out of the reproductive phase of their lives into a very productive and meaningful stage of their lives. They can pursue an interest outside the home and focus on personal development without guilt and overwhelming family obligations. However, for many women, this transition is filled with physical and emotional changes.

Menopausal symptoms are more common in women in industrialized nations or with specific diets and lifestyles. Women in the United States and Europe complain more of menopausal symptoms than Asian women or women from less industrialized nations. Women in Asia have no word in their language for hot flashes because they are non-existent in their culture. However, if an Asian woman moves to America or Europe and adapts the diet and lifestyle the likelihood of menopausal symptoms is equal to an American woman. This phenomenon tells us that menopausal symptoms are not genetic and unavoidable. Diet, lifestyle, and the environment play a role in the difficulties experienced during menopause.

Billions of dollars have been spent to convince women that estrogen is the one and only answer for the treatment of menopause. However, less than 20% of women take hormone replacement therapy(synthetic estrogen) for more than one year. It is time to ask the question: Are 80% of American women wrong or are there other treatment options that they should explore.

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Menopause is not caused by Estrogen Deficiency

Menopause occurs when a woman permanently stops ovulating or producing an egg that can be fertilized and used for reproduction. Menopause is diagnosed when a woman no longer has a monthly cycle for a year and has an elevated blood level of FSH (follicular stimulating hormone). FSH is elevated when a woman stops ovulating or producing an egg. FSH is not an indicator of estrogen deficiency. Unfortunately, FSH levels are what most doctors use to diagnose menopause. Estrogen is made from a variety of sources.

The ovary is only one of many sources. Estrogen is available because hormones that are made by the adrenal gland can be converted into estrogen in fat, muscle and skin cells. Estrogen is also available through food sources such as soy, and flaxseed. We are exposed to many chemical substances in the environment that behave like powerful estrogens. With the abundance of sources of estrogen available in the environment and the other sources available in the body, it seems unlikely that estrogen deficiency is the problem. When estrogen levels are obtained from saliva testing, most menopausal women have normal or elevated levels of estrogen.

Menopause: Estrogen or Progesterone Deficiency

As we discussed earlier, FSH is commonly used by doctors to diagnose menopause. FSH is elevated when ovulation or egg production ceases. The hormone that is directly dependent upon ovulation is progesterone.

While estrogen can be produced from a variety of sources within the body and externally; progesterone is only produced after ovulation.

Estrogen and progesterone are produced together throughout the reproductive years and function best when they are produced in their normal balance.

Estrogen is produced prior to ovulation to replenish the inner lining of the uterus that was lost during the menstrual cycle. Progesterone causes the uterine lining and the breast to further develop to prepare for a possible pregnancy.

Estrogen and progesterone also affect other organs like the brain, the endocrine system, the immune system, etc. When these hormones are present in the normal levels they balance and counterbalance each other’s activity and do not cause any symptoms.

Progesterone and Menopause

During and after menopause ovulation ceases and so does progesterone production. Progesterone cannot be made from other hormones and it is not found in the environment in any significant amount. To counter the effects of progesterone deficiency, the body begins to make testosterone and other male hormones.

Male hormones cause menopausal women to grow facial hair and develop male pattern baldness. Testosterone can be produced by the ovary and the adrenal gland after menopause. The body uses this hormone to balance estrogen in the absence of progesterone. Replacing progesterone usually reverses the process and initiates the growth of scalp hair and stops facial hair growth.

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Why is progesterone so important?

It does more than just balance estrogen. Progesterone is vitally important to the normal functioning of several organ systems in the body. The functions of progesterone include using fat for energy, decreasing water retention, eliminating depression and anxiety, improving mental function, and increasing the sex drive and effectiveness of other hormones like thyroid hormone, testosterone, and estrogen.

A deficiency of progesterone can explain most of the symptoms of menopause
Hot flashes occur when the pituitary gland, located in the brain, attempts to force the ovary to ovulate to make estrogen and progesterone. When progesterone provided is in proper amounts, the hot flashes decrease because the pituitary gland assumes ovulation is functioning normally since progesterone is around.

Mood swings can also be traced to progesterone deficiency or an estrogen excess
Progesterone has a calming sedative effect on the brain. It attaches to a GABA receptor in the brain that decreases anxiety and elevates mood. The GABA receptor is the same receptor that antidepressants and anti-anxiety drugs bind to and produce their effect on the brain.

Insomnia is another frequent complaint of women during menopause.
The insomnia is probably due to the lack of the calming effects of progesterone. Replacing progesterone usually improves insomnia.

Many women complain of poor concentration and lapses in memory during menopause
Progesterone is involved in providing insulation to nerve cells. Myelin which surrounds nerve cells acts like rubber around electrical wires. Myelin insulates nerve cells and improves the conduction of nerve impulses. Decreased progesterone may interrupt the production of myelin and interfere with brain impulses.

Estrogen without the proper amount of progesterone can interfere with thyroid hormone function.

Hot Flashes

If most women need progesterone why do hot flashes go away when women take estrogen The body is reacting to a relative deficiency in estrogen. Even though most American women have normal to high levels of estrogen during menopause when the ovary stops making estrogen during menopause the body recognizes it as lower than normal.

In an attempt to stimulate the development of an egg in the ovary, the pituitary gland becomes overactive. The pituitary gland tries to stimulate the ovary by releasing excessive amounts of FSH. The pituitary gland is adjacent to the area in the brain that controls body temperature. It is believed that the overactivity of the pituitary stimulates the temperature center and produces hot flashes.

Estrogen replacement returns the estrogen level back to the level prior to menopause. The problem with estrogen replacement alone estrogen levels rises while progesterone levels remain low. Progesterone decreases the amount of estrogen that is required to avoid menopausal symptoms. By providing adequate amounts of progesterone through BHRT, the symptoms of estrogen excess can be lessened. Breast tenderness, weight gain, bloating, fatigue, blood clots, and increased breast cancer risks are all associated with excessive estrogen which can be avoided. Replacing estrogen produces short-term relief but can cause long-term problems, which explains why less than 20% of women remain on estrogen for more than one year.

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Do I Need Estrogen?

Menopause cannot be simply explained by a lack of estrogen. While estrogen deficiency may play a role in some women’s experience in most cases it does not. Most women in America are over their ideal body weight. It is well documented that overweight women produce too much estrogen. Estrone, an estrogen, is made in fat cells. It is a relatively strong estrogen when compared to estrogens made by the body. Women who are overweight are at an increased risk of diseases that are known to be caused by elevated estrone levels. Uterine cancer and breast cancer are more common in women who are overweight.

Women that are overweight are more likely to be diabetic. Women who are diabetic are more sensitive to estrogen than women who are not diabetic. Estrogen also increases weight gain and makes it more difficult to lose weight. Women who are overweight should not take standard synthetic estrogen replacement.

Women who are not at high risk for osteoporosis should avoid estrogen replacement. Estrogen has two FDA-approved indications. One is the relief of hot flashes the other is the prevention of osteoporosis in high-risk women.

Women that have a thin frame, and of North European descent with extremely fair skin, sedentary lifestyle, history of smoking, and prolonged steroid use are at risk for osteoporosis.

Women that are not in a high-risk group do not need estrogen to maintain normal bone health. African-American women and other people of color are at very low risk for osteoporosis and should not take estrogen for osteoporosis prevention. Although very thin fair-skinned African American women may be at risk. Overweight women do not have to worry about osteoporosis. Osteoporosis is very uncommon in women over their ideal body weight especially if they have no other risk factors.

Another myth about estrogen replacement is that estrogen prevents heart disease.
Estrogen does not prevent heart disease. There is no evidence that estrogen alone alters the risk of heart disease.

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