By Dr. McKenzie Nisbet, ND

Menopause: The Basics

MENOPAUSE: THE BASICS

Millions of women experience menopausal symptoms each year, however there is often confusion over when menopause starts, what’s happening below the surface and what options we have for testing and treatment. Let’s start by defining a few terms.

DEFINING THE TERMS

PREMENOPAUSE starts at puberty and continues into your 40s (typically). During this time, you (should) have regular cycles.

PERIMENOPAUSE marks the time before menopause when hormones are shifting. This typically occurs in your 40s and 50s and symptoms often start here.

MENOPAUSE is reached after 12 consecutive months with no period. Symptoms can carry through peri-menopause into menopause.

THE HORMONAL SHIFT

During perimenopause hormones such as progesterone, estrogen and testosterone decline.

PROGESTERONE is ONLY produced when we ovulate. In a perfect world this happens predictably once each month. During perimenopause women ovulate less consistently and our cycles become less predictable. No ovulation means no progesterone spike. Less progesterone can trigger issues such as insomnia and feelings of anxiety due to less GABA receptor simulation.

ESTROGEN levels gradually decline during this time as well. This decline can be at an irregular pace, which is why symptoms can vary. The reduction in estrogen increases the risk for osteoporosis and cardiovascular disease and can trigger vasomotor symptoms such as hot flashes and night sweats, brain fog and vaginal dryness.

TESTOSTERONE naturally declines as we age. Testosterone peaks in our 20s and continues to decline through perimenopause and menopause. Proper sleep and resistance training are important to support hormone production.

This hormonal shift can be unpredictable. Some days or months can be good and some days or months can be full of symptoms. For some women this transition is easy for others it’s a roller coaster ride of symptoms including:

If you are one of the lucky ones with a smooth transition – fantastic. If you are one of the many facing these symptoms – get to know your testing and treatment options.

INVESTIGATING YOUR TRANSITION

Every woman presents with difference symptoms. Knowing your numbers helps create a more targeted treatment plan.

TRACKING. Track your symptoms. These can vary day to day and month to month. Monitoring the number of hot flashes, severity of night sweats, sleep changes, cycles, etc. can help us understand your unique picture.

COMPREHENSIVE TESTING. The DUTCH test is my favourite for getting an overall picture of your sex hormones and adrenal function.

BLOOD WORK. Depending on your specific symptoms, we can use different blood parameters to uncover imbalances and deficiencies. Here are some of the parameters I commonly run with my peri-menopausal patients:

• Thyroid Panel (TSH, Free T3, Free T4, Anti-TPO, Anti-TG). Often run when symptoms of under-active thyroid are present (fatigue, dry skin, hair loss, etc), or when weight is a major concern.
• Insulin, Glucose and Leptin. These parameters are used to determine if there is an underlying insulin resistance or leptin resistance contributing to weight gain.
• Vitamin B12 and Iron. These are commonly used when fatigue is a major concern, when there is abnormal bleeding, or when thyroid concerns are present.
• Vitamin D. Risk of osteoporosis increases with menopause due to the reduction in estrogen levels. We want to ensure adequate Vitamin D levels are maintained to support bone health.
• Cholesterol and HbA1c. Lipid levels can shift during peri-menopause. Running a full lipid panel and HbA1c (blood sugar) lets us monitor for any unwanted increases/declines. We can then intervene with diet, lifestyle or supplement support as needed.

TREATMENT OPTIONS

It is important to remember that what was working for you at 20 or 30 may no longer be working at 40 or 50. Adjustments to diet and lifestyle are often needed as we enter this transition.

Depending on your symptoms experience and lab results we can create a treatment plan unique to your goals. Treatment can include dietary and lifestyle changes, nutraceuticals, herbal medicine (to support thyroid, adrenal and sex hormones), and/or bio-identical hormone therapy (BHRT) such as topical progesterone cream.

Get to know your options. Schedule your Free 15-Minute Meet & Greet here and lets chat!