Menopause Is Fun
Talk about a shift . . .
Oh those late 40's and early 50's . . .
They've arrived and with these years, they've come with a 10 pound weight gain (wait, I wasn't done getting the baby weight off!) despite lots of cardio and a clean diet. What gives?
Waking up in the middle of night feeling like someone turned up the heat to 120 degrees, one leg out of the covers and one leg under the covers, I'm thankful that it's winter here. Sleeping with the window open while the house pumps out heat for everyone else - but me. No thanks. I'm my own personal radiator.
Everyday I tie up my running shoes and hit the pavement for 3 miles (5 on a good day) and I'm insistent on working off this new inner tube that has become my stomach. Oh but first coffee. Organic coffee with coconut milk helps shake off my sleepiness and get me going a bit. It's a good day when my man brings it to me bedside, the aroma of coffee hits my nostrils first and becomes my cattle prod.
Between my son going through puberty and his sophomoric, know-it-all attitude and my deniable hormonal shift, there are more hormones bouncing around this house than plastic balls in those bouncing house pits. We both use ("yell") the phrase "you don't understand me" quite a bit at each other these days.
I get through the day rather well. One of the strategies I've used to keep focus includes writing my daily goals on my white board so I can keep on track and not drift into scrolling through social media believing everyone's life must be easier than mine.
I look forward to 5:00 pm because that means I can cook dinner and have a glass of wine. This would look so glamorous except I'm still in my yoga pants, hair not only "undone" but "never done". I make a nice medley of vegetables with a side of clean protein. I got this, especially knowing that I have some chocolate stashed in the cabinet later to eat with my second glass of organic red wine. Who am I kidding? I don't have to stash or hide it. The teenager hates dark chocolate.
It's Menopause Groundhog's Day
The next morning starts out the same way as all the other mornings - after a night of restless sleep, waking up in the middle of the night for no apparent reason other than to have a few more hot flashes and a couple trips to the bathroom.
Where's my damn coffee? (Read: Need that prop-me-up called caffeine)
I can't remember where I put my keys. (Read: My brain isn't working anymore)
That tiny thing you did really pissed me off! (Read: My emotions are all over the place)
Does this sound like you?
Women can have drastically different experiences going through menopause. There I said it. MENOPAUSE.
Menopause is not a "medical event". The body is asking (begging) us to be open to change. Even our optimal lifestyle before is not going to serve us optimally now at all.
We are also moving from an ovary-dominant phase of life to an adrenal-dominant phase of life. Imbalances that women have been ignoring/tolerating in the past may worsen and become impossible to ignore now. This is an opportunity for positive awareness and growth versus a frustrating, annoying, disruptive time of life.
Less Progesterone and Estrogen Rules
In post-menopause, the adrenal gland is the only tissue that makes notable progesterone. The ovaries have done their job in the past and they are shutting down.
They continue to produce small amounts of estrogen. Body fat (adipose tissue) makes the majority of estrogen (did you know fat is an endocrine tissue)?
While overall hormone levels go down in menopause, having a balance between estrogen and progesterone is still important!
As we age, we rely on our adrenals to make progesterone for us. But if we are using all of the hormones produced by our adrenals elsewhere in our bodies due to stress, we don't have much left to produce progesterone. (This is called the "pregnenolone steal" in clinical circles).
Pregnenolone is a precursor hormone - the Queen Bee of Hormones. From cholesterol, it uses cellular energy known as ATP to make this happen. It's not an efficient process as it requires a lot of cellular energy. It's important to make pregnenolone however as it's job is to make all the other hormones we need like estrogen, testosterone, progesterone, aldosterone, and cortisol.
If you feel like what one of my clients called a "dead battery" in the morning, I'd venture to bet you have low awakening cortisol and cannot function without coffee.
If you've used all of your pregnenolone to make cortisol to deal with all the stresses you encounter in the day, you don't have much to make the right balance of hormones and to have some cortisol to wake you gently in the morning and enough melatonin to rock you to a deep sleep at night.
Hormone balance in menopause is highly dependent on effective stress management (mindset to prioritize one's care and ease is key!). Regular and sound sleep, self-care, having support - all of these aspects become more important, not less. With ongoing stress, the HPATG axis will shift hormone balance from the adrenals, providing insufficient progesterone to keep estrogen receptors primed. Women can indeed have estrogen-dominance due to rock-bottom progesterone (and perhaps overload with xenoestrogens) but still have hot flashes due to dramatic fluctuations in estrogen.
Lifestyle matters . . . a lot
You know I was going to say it. I feel like I'm about ready to steal the pacifier and favorite blanket from a baby....you ready???
Beverages like coffee and alcohol are not necessarily negative lifestyle choices, but in the case of hot flashes, they can both definitely be exacerbating factors. I know this is painful. I've been there sister. I have had many clients who noticed dramatic reductions in hot flashes simply by drinking less alcohol (or by at least not drinking wine at all) and drinking less coffee.
Blood sugar fluctuations will exacerbate hot flashes. It's important that your breakfast include some protein and a good dose of healthy fat. Indeed, I would make carbohydrates a very small portion of your breakfast.
How about a higher protein breakfast (e.g. two eggs with some mixed greens, sprinkle of seeds, and perhaps some avocado and a couple berries) for a few days in a row?
Post-menopause, many women find the need to modify their diet to a lower glycemic one in order to retain the metabolism they enjoyed pre-menopause. I usually recommend eliminating all sweetened beverages and all grain flours with a strong focus on vegetables, nuts/seeds, fruits.
Dinner foods that are likely to results in a blood sugar crash several house afterward (e.g. pizza, pasta, sugary dessert) further disrupt sleep. An ancestral approach with healthy fats and clean protein may serve your nighttime slumbers better.
Want to check this? Have your practitioner order your fasting insulin and HbA1c (instead of just fasting glucose). These markers will give greater insight into any insulin resistance at play.
Certain foods (phytoestrogens) which are considered weak estrogens can be helpful. They attach to estrogen receptors blocking the entrance for the more powerful (and symptom provoking) estrogens. These include freshly ground flaxseed, chaste-tree berry, maca root, and other herbal extracts such as dong quai, red clover and black cohosh.
However each of these phytoestrogens are more or less helpful at different stages of peri-menopause and post-menopause. It requires some experimentation - and to get it right - a test called the DUTCH test to come up with a more dialed-in accurate protocol for your unique body.
Lab data is very helpful . . .
If you want to learn more about your body, labs prior to any intervention capture an accurate baseline vs. later after numerous changes have been implemented.
In terms of the big picture, I think it's absolutely critical to get a current thyroid panel (specifically at least TSH, Free T4, Free T3, Reverse T3, and TPO/Tg antibodies) especially if there is any sign of thyroid dysfunction. If your thyroid is off, everything will be off - no matter what supplements you throw down your throat. There can be an autoimmune dynamic at play driving weight, mood and sleep challenges.
All hormones affect each other. Highly fluctuating estrogen levels or net estrogen dominance (a common state for obese women in menopause due to very low progesterone) may now be affecting previous thyroid stability (e.g. levels of bound vs. free hormones or levels of cortisol that are highly elevated or suppressed).
Power of DUTCH
I also recommend a urinary hormone test (DUTCH). Conventional medicine focuses primarily on estrogen in menopause, but low cortisol (from sustained stress) and low progesterone (also due to menopause, but perhaps exacerbated by stress as well) often play a dominant role in symptoms.
I often find that my clients who struggle with hot flashes almost entirely at night (vs. during the day) have low overnight cortisol (due to low adrenal output), and this is a root cause that must be addressed directly for relief.
Ample cortisol is key for maintaining optimal blood sugar during periods of fasting. The body may experience a surge of adrenaline (perceived as a "hot flash") if cortisol is too low in an effort to force the liver to release glycogen to glucose. If there is insulin resistance and higher fasting insulin, this dynamic will just be exacerbated.
Can you see how needing coffee instead of getting natural cortisol is a BIG SIGN that your body needs some loving?
Aggressive Exercise and Makeup
I know its counter-intuitive but aggressive exercise can actually be the cause of that inner tube around your belly button! That's the thanks we get for working out so hard.
Aggressive exercise is actually stress on the body and the body in all its wisdom says "save some fuel for later because stress means starvation!" Depending on my client, I recommend gentle (not power) yoga, pilates and intermittent / interval cardio and weight training. There is not a one-size-fits-all approach.
And lastly, makeup, beauty products and perfume. These contain a ton of chemicals, many of which are in the category of "xenoestrogens" and these chemicals trick the body and make the body produce way too much estrogen we need. Remember where estrogen is both stored and produced - body fat. This isn't limited to women. Men get boobs too because of xenoestrogens.
Need Help Figuring This Out?
I've been there. Heck, sometimes I fall off the wagon and have my coffee, wine and dark chocolate too and WHAM...right back into the hot zone. This is a healthy (and effective) reminder that change takes work and consistency and sometimes you need someone to help you. I'm here if you would like to talk - get your complimentary meet and greet session scheduled.
Let's ride into that next amazing stage of life together.
What's the most annoying part of this transition? Share your thoughts below!
Also published on Medium.