Menopause

Graduating to the Freedom of the “Renewal Years”

Menopause is the phase of life that begins 1 year after your final menstruation.

Why Menopause Occurs

  • unique to humans and a few species of whales, and probably has to do with our shared matrilineal social groups

  • humans evolved to have decades of longevity in a post-reproductive state

  • this allowed for humans to care for their family groups, to pass down culture and knowledge, and increase the family’s survival chances

  • it’s likely that this natural selection made our species more resilient during times of hardship

  • menopause is framed as a rite of passage in many cultures, and there are countless ways to experience it, including complex feelings of grief

  • menopause is a kinder, more peaceful, and more childlike state

  • menopause is not a deficiency

How The Body Shifts Its Estrogen Production

upregulating aromatase

increasing androgen production

increasing number and sensitivity of estrogen receptors

Intracrinology

  • Intracrinology is the tightly regulated local cellular production of estrogen

  • Ovarian estrogen production drops 90%, but you still need estrogen in menopause. It performs different functions throughout your life especially in your brain and heart

  • Estrogen instead starts to be made locally inside your cells with an androgen-converting enzyme called aromatase

  • Aromatase can convert androgens (testosterone, androstenedione) into estrogens (estradiol, estrone)

  • Intracrinology is how all non-menstruating people (including men and children) make estrogen

  • Upregulation of aromatase is normal as it helps provide you with estrogen

  • Too much aromatase activity in abdominal adipose tissue can overproduce estrone, which causes menopausal symptoms and increases your risk of cardiovascular disease

  • Insulin resistance causes this aromatase upregulation and needs to be addressed

  • healthy levels of DHEA supports intracrinology and intracellular estrogen

  • Because most of your menopausal estrogen is made and used right inside your cells, blood test levels aren’t accurate

Other Menopausal Changes

Cognitive Changes

  • menopause is a neurological transition that you adapt to

  • losing estrogen and progesterone is hard for the brain because it used these hormones to calm neurons, perform neurogenesis, reduce inflammation and regulate your circadian rhythm

  • healthy HPA axis functioning is essential to resilience, brain does fully recalibrate to this new state

Immune Changes

  • low progesterone means loss of the calming effects on the immune system (preventing overactivation)

  • inflammation increases likelihood of autoimmunity

  • low thyroid hormones can trigger autoimmunity

Cardiovascular Changes

  • risk increase from insulin resistance

  • high estrone from excess aromatase activity also impacts risk

  • reversing insulin resistance is key to reducing risk

  • magnesium and movement also mitigate cardiovascular effects

Metabolism Changes

  • reduced estrogen and very low progesterone increase risk of insulin resistance

  • untreated insulin resistance can lead to type II diabetes, high triglycerides, and high non-HDL cholesterol

  • low progesterone reduces free or available thyroid hormones

Bioidentical Hormone Therapy

Estrogen

  • avoid taking estrogen by itself

  • if you entered menopause naturally after age 45 and have no symptoms or osteoporosis risk, you don’t need to take estrogen

  • if you’ve been in menopause 10+ years, estrogen therapy can be harmful

Progesterone

  • progesterone relieves symptoms of natural menopause but not surgical/medical induced menopause

  • progesterone is safe to use alone if you can’t use estrogen or react badly to estrogen or combined therapies

  • cream helps with most symptoms but capsules are necessary to protect uterus

Testosterone

  • should only be used if already using combined estrogen and progesterone therapy

  • testosterone can be prescribed for libido and clitoral sensitivity

  • testosterone is more risky as it can increase insulin resistance

  • if insulin resistance or breast cancer are not risk factors for you, you can try a low dose but watch for side effects

Estrogen + Progesterone

  • if you entered menopause naturally after age 45 and have symptoms or osteoporosis risk, you’ll benefit from taking both estrogen and progesterone

  • if you had early menopause or surgical/medical induced menopause before age 45, consider estrogen and progesterone therapy as a preventative