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Hot flashes and beyond: Perimenopause 101




This is a big topic I see often in my practice. Lets cover some 101 terms and then dive into suggestions!


Menstrual Cycle hormones

  • FSH – Follicle Stimulating Hormone

    • Stimulates growth of eggs in ovaries

  • Estrogen – Estradiol or E2

    • Thickens lining of uterus to prepare for pregnancy

  • LH – Luteinizing Hormone

    • Helps trigger release of egg from ovary

  • Progesterone

    • Prepares the lining of uterus for a fertilized egg to implant and grow


Across the Lifespan terms

  • Premenopause – monthly menstrual cycle

  • Perimenopause – Can last up to 10 years

  • Postmenopause – 12+ months without cycle


Perimenopause & Menopause “Classic symptoms”

  • Changes in menstrual cycle: longer, shorter, heavier, lighter, skip a cycle or two

  • Hot flashes & night sweats (vasomotor symptoms)

  • Sleep disturbances & fatigue (insomnia, waking up at night, daytime sleepiness)

  • Mood changes: meno-rage, depression, anxiety

  • Low libido, vaginal dryness, orgasm difficulty

  • Brain fog or concentration issues


Other Possible Changes

  • Skin changes: dry, wrinkles, acne

  • Hair changes: rogue hairs, thinning

  • Vaginal changes: dryness, UTIs, yeast infections, incontinence, painful intercourse

  • Swelling of hands & feet

  • Bone & muscle loss

  • Chest palpitations

  • Aching joints or more body pain

  • Changes in weight distributions, abdominal weight gain

  • Cholesterol & cardiovascular risk increases

  • Dental changes: tooth & gum loss, dry or burning mouth

  • Eye changes: dry eyes, blurred vision, redness, cataracts


What Can Help?

  • Dietary changes-whole foods, protein focused

  • Weight lifting and movement/ exercise

  • Addressing underlying issues: infections, thyroid, adrenals

  • Hormone replacement therapy (conventional)

  • Bio-identical hormone replacement therapy

  • Herbs, supplements

  • Cognitive behavioral therapy

  • Sleep hygiene

  • Acupuncture

  • Chiropractic care

  • Craniosacral therapy


What Happens To Us As We Age? Women

  • Decrease in progesterone

  • Decrease in estrogen

  • Rise in (LH) luteinizing hormone

  • Eventual rise in (FH) Follicle stimulating hormone


Note that a good way to tell if you are in perimenopause if your LH level is elevated, but once your FH elevates you are in menopause.


My favorite self-order kits are from ZRT which I’ll detail at the end.


Main Hormones Affected

  • Luteinizing Hormone (LH)

    • Rises and works in over drive to tell ovaries to make more estrogen

      • 14-53 IU/L

      • Peri 14-16

      • Menopause 16+

  • Follicle Stimulating Hormone (FSH)

    • Happens secondary to LH and stays elevated for life in response to low sex hormones

      • 25-53 MIU/ML

  • Estrogen/Estradiol

    • Lowers in Peri/Menopause

      • Below 0-30 PG/L

  • Progesterone

    • Lowers in Peri/Menopause

      • Less than 1 NG/ML

  • Cortisol

    • Could be extremely high or low

      • Optimal cortisol 10-15 MCG/DL


What You May Be Experiencing in Perimenopause/Menopause

  • Symptom

    • Could be caused by

  • Insulin Resistance

    • Low estrogen

  • Night sweats

    • Low progesterone

    • Fluctuating estrogen

  • Weight gain specifically in stomach

    • Lifestyle choices & improper diet

    • Insulin resistance due to low estrogen

  • Lack of energy

    • Cortisol imbalance

    • Low progesterone

  • Low libido

    • Low estrogen

    • High cortisol

  • Lack of sleep

    • Low progesterone

    • High cortisol


Basic Supplement Suggestions for the Peri/Menopausal Women

  • Vitamin D with K – as vitamin D drops in menopause it can lead to bone loss, fatigue and insulin resistance

  • Fish oil – Fish oil is shown to have a positive effect on low estrogen and progesterone levels

  • Magnesium Glycinate – is shown to keep bones healthy and strong. Studies also show that it can help with hot flashes. It is also known to boost estrogen.

  • B-complex – As all of the B vitamins serve as cofactors in the production of estrogen


Peri Menopause – Additional Supplements

  • Black Cohosh – 20-80 MGS per day

    • Works specifically to combat hot flashes and night sweats

  • Chasteberry – 200-800 MGS/Day

    • Can improve mood and fatigue by balancing estrogen and progesterone

  • Ashwagandha – 600-1200 MGS/day

    • Helps with fatigue and nourish the adrenals-take at night

  • Berberine – 1,000-1,500 MGS/Day

    • Improves insulin resistance

  • Digestive Enzymes

    • As estrogen lowers it can cause a decrease in digestive enzymes and create more gas and bloating


Nutritional Considerations for the Peri/Menopausal Woman

  1. Adequate food intake – Chronic undereating and dieting can lead to down regulation of hormones such as estrogen, progesterone, and testosterone. Likewise, it can put additional stress on the body and lead to increased Cortisol. In this case women should consider reverse dieting their calories back up to an appropriate intake. Adversely, over consuming food can lead to inflammation, blood sugar regulation issues, insulin resistance, weight gain, and mood disorders.

  2. Increase foods high in omega 3s and 6s

    1. Increasing omega 3s help reduce inflammation in the body and help with hormone regulation. Here are some examples: Salmon, sardines, walnuts, olive oil, flaxseed, chia seeds, and soy beans

    2. Omega 6s can help regulate hormones. Examples of good Omega 6s are: coconut, pistachios, pumpkin seeds, sunflower seeds and primrose oil.

  3. Focus on Fiber

    1. As we enter into menopause due to the drop in progesterone your body may become more insulin resistant. It is important to get an adequate amount of fiber for blood sugar regulation. Shoot for a minimum of 21 grams daily.

  4. Incorporating seeds

    1. Flaxseed and pumpkin seeds can help boost estrogen. Try 1 tbsp of each daily.

    2. Sunflower seeds and sesame seeds can help boot progesterone. They can also be incorporated at 1 tbsp daily.

  5. Reduce alcohol

    1. Excessive alcohol use can increase inflammation in the body and also decrease alcohol levels in the body.

  6. Carbohydrate Timing

    1. Insulin sensitivity is highest during and after workouts. Consider having your higher carb meals around your workouts if insulin resistance is an issue. Load up on healthy protein, veggies, and fats at other times of day.

  7. Focus on Anti-inflammatory Foods

    1. Lean proteins, healthy fats, vegetables

  8. Dieting should be infrequent

    1. Caloric deficits should now be infrequent and if you do diet it should not be extreme


Symptoms of Low Testosterone

  • Low libido (decreased sex drive)

  • Decreased sexual function

  • Decreased muscle mass and strength

  • Difficulty concentrating

  • Brain fog

  • Higher number of aches and pains

  • Wrinkled and old skin

  • Thinning hair/skin

  • Hot flashes

  • Inability to go to the bathroom

  • Depression

  • Higher levels or worry, anxiety, and fear

  • Lack of drive (feeling unmotivated)

  • Low self-esteem/low self-confidence

  • Inability to make quick decisions

  • Tiredness

  • Weight gain (especially in the mid-section/accumulating visceral fat


How to Boost Testosterone Naturally

  • Focus on weight lifting, but avoid overtraining

  • Stress management

  • Regular consumption of foods high in phytoestrogens (plant-based estrogens, commonly found in soy and flax seeds) can also DECREASE testosterone levels

  • Get 7-8 hours of sleep a night

  • Alcohol raises estrogen, which can create estrogen dominance; it also increases the production of SHBG (sex hormone binding globulin) of which lowers free testosterone, and depletes zinc, resulting in a lower testosterone production


Got Cravings?

Chocolate

Low on Magnesium

Eat seeds, nuts, fruits, and veggies

Sugar

Low on chromium

Eat fresh fruit

Bread, Pasta, other carbs

Low on nitrogen

Eat protein rich foods such as salmon, nuts, meat, beans

Salt

Low on chloride

Eat fatty fish, goat milk, cashews, nuts and seeds


As part of ongoing work with women 40+ I do a full clinical intake as well as a saliva hormone and cortisol panel and set up a plan based on symptoms that include dietary changes, supplements, lifestyle changes, and medical options as needed.


HERE is the ZRT panel I most use. You can order this anytime. I use these results along with your basic blood chemistry results and pull information from your symptom list to help you reach your goals in the most natural way possible.




Keep Moving Forward 😊 Sarah


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