Throughout this series so far, we have learned that menopause is a period of time that begins once a woman’s body is done having menstrual cycles. As a woman experiences fluctuating levels of estrogen and other reproductive hormones, she will walk through four distinct stages of menopause:
When most individuals think of reproductive hormones, testosterone and estrogen are the first (and often only) ones that come to mind. Of course, testosterone and estrogen are vitally important hormones for the body to function properly, but several other hormones are affected by menopausal changes as well. Because of this, supplementing with estrogen is not always the best answer for most women.
Estrogen supplementation can help to alleviate menopausal symptoms but estrogen may not be the hormone a woman’s body needs as it goes through menopause. Supplementing with hormone therapy like the estrogen-progestin pill significantly increases a woman’s risk of conditions such as stroke, heart disease, breast cancer, and blood clots, as well as increasing inflammatory markers.
Before supplementing with estrogen, it’s important to consider hormone precursors and the role they play in the overall wellness of a woman’s body throughout menopause.
Hormone precursors are essentially hormones that are converted into other hormones. These precursor hormones directly affect the amount of other hormones in the body. Precursor hormones are a vital part of the hormonal cascade that allows the body to function like a well-oiled machine. If the precursors are missing, parts of the machine are missing and everything may not properly work together for optimal health and wellness, and the body will not experience the benefits that other hormones can provide.
Most precursor hormones are produced in the pituitary or adrenal glands.
The pituitary gland is located in the brain and responds to signals from the hypothalamus, the main control center of your brain. The anterior pituitary gland produces:
Adrenal glands are small glands that are located above the kidneys. The adrenal glands produce several very important hormones, especially during and after menopause. These include:
Hormone replacement therapy (HRT) has been the standard of care for women in menopause with both conventional and integrative physicians. HRT utilizes synthetic hormones in an effort to “top off” a woman’s hormone levels. This can help alleviate many of the common menopause symptoms that women experience.
There are two main types of HRT:
Women who undergo HRT with synthetic hormones are at an increased risk for a variety of complications including:
From the functional standpoint, there is a time and place for bioidentical hormone replacement therapy.
Bioidentical hormone replacement therapy (BHRT) was born through the need and patient demand for an alternative to HRT for those looking to avoid synthetic hormones. Bioidentical hormones are made to biochemically mimic the hormones produced in a woman’s body. This means that the endocrine system cannot distinguish them from their own natural hormones.
BHRT hormones are formulated using plant-based substances including soy and yam. This made them a more appealing, “natural” form of hormone therapy. However, there are some considerations to be weighed when considering BHRT.
While BHRT can be helpful for some women with specific conditions for short periods in small doses, there is more to consider when treating a patient. If a patient’s lab report indicates that they are low in certain hormones, it is not best to simply treat the patient to raise their hormone levels back to an optimal range. Instead, the first question should be to consider why the levels are low in the first place.
If the hormonal cascade is not working properly, and a woman’s body is not properly converting precursors, treating low levels of hormones with BHRT may not solve the issue.
BHRT can be extremely effective in relieving negative symptoms for women in menopause. As always, it is important to monitor hormone levels regularly in order to observe what is occurring in the body. Long-term use of BHRT can actually worsen the problem by causing negative feedback loops within the hypothalamus-pituitary-thyroid-adrenal-gonadal axis (HPTAG axis). The HPTAG axis is a complex communication network between the brain, endocrine glands, hormones, and neurotransmitters that controls cellular activity, growth, metabolism, stress response, reproduction, general homeostasis, and various other functions.
Essentially, HPTAG axis suppression means that the pituitary gland recognizes the higher hormone levels from long-term BHRT use and signals the body to stop producing those hormones on its own. This can lead to hormone resistance, as the body becomes accustomed to high levels of hormones without having to work to produce them.
BHRT in small, controlled doses over a brief period can be extremely helpful in eliminating undesirable menopause symptoms for some women.
When a woman’s ovaries are no longer releasing eggs, they are also no longer producing estrogen or progesterone. This leads to dramatic hormonal changes resulting in many of the common menopause symptoms. BHRT may help to balance estrogen and progesterone levels in the body, relieving symptoms for some.
Additionally, supporting the adrenals before and through all stages of menopause is crucial to managing hormone levels. If someone has an unsupported thyroid condition, the body depends more heavily on adrenals, as the thyroid is intimately involved with hormone function. Menopausal symptoms arise when a woman is already depending on adrenals for hormones. BHRT can be effective in taking strain off of the adrenals and allowing them time to repair in order to produce the appropriate levels of hormones once again.
It is vitally important to keep a close watch on hormone treatments to ensure they are being safely and effectively used.
After treatment begins, the clinician should follow up with testing in six to eight weeks and have maintenance check-ins to keep a close eye on hormone levels. Retesting hormone levels once on BHRT is especially critical. Hormones can elevate to dangerously high levels, which can predispose women to endocrine-based cancers.
Additionally, choosing a skilled provider is key to having success with hormone replacement therapy.
The functional approach to menopause and overall hormone health focuses on healing and restoring a woman’s proper physiological balance to the endocrine system. It’s important to work with a provider to support the body to be stable throughout menopause.
This approach includes evaluating:
Choosing whether to pursue hormone therapy to relieve menopause symptoms can feel like an overwhelming decision. Working with a skilled and knowledgeable provider whose ultimate goal is restoring proper endocrine function in the body is a great starting point on the journey to balancing hormones.
To learn about the essentials of menopause, read Part 1: A Quick, Essential Guide to Menopause
To learn about how menopause affects your blood sugar, read Part 2: Menopause, Blood Sugar, and Weight Management