Menopause can be a difficult transition in a woman’s life. Menopause usually occurs between ages 48 and 52. The onset of hot flashes, extreme mood swings, insomnia, hair loss, uncontrollable weight gain, skin changes, vaginal dryness, decreased sex drive, the fear of osteoporosis, breast cancer and heart disease all are a part of American women’s experience.

Menopause is a normal transition experienced by women. They are transitioning out of the reproductive phase of their life into a very productive and meaningful stage of their life.

This is a time when the question of pregnancy is no longer an issue. Children are independent and a woman can pursue interest outside the home and focus on personal development without guilt and overwhelming family obligations.

However, for many women this transition is filled with physical and emotional problems. Why is this normal transition so difficult for so many women?

Menopausal symptoms are more common in women in industrialized nations or with specific diets and lifestyles. Women in the United States and Europe complain more of menopausal symptoms than Asian women or women from less industrialized nations.

Women in Asia have no word in their language for hot flash because they are non-existent in their culture. However , if an Asian woman moves to America or Europe and adapts the diet and lifestyle the likelihood of menopausal symptoms is equal to an American woman.

This tells us that menopausal symptoms are not genetic and unavoidable. Diet, lifestyle and the environment must play a role in the difficulties that can be experienced during menopause.

This newsletter will answer some of the questions about what really occurs during menopause. Billions of dollars have been spent to convince women that estrogen is the one and only answer for treatment of menopause. However less than 20% of women take hormone replacement therapy ( synthetic estrogen) for more than one year. It is time to ask the question: Are 80% of American women wrong or is estrogen the wrong answer for the majority of American women.

Menopause is not caused by Estrogen Deficiency

Menopause occurs when a woman permanently stops ovulating or producing an egg, in the ovary, that can be fertilized and used for reproduction. Menopause is diagnosed when a woman no longer has a monthly cycle for a year and has an elevated blood level of FSH. FSH is elevated when a woman stops ovulating or producing an egg. FSH does not reflect the amount of estrogen a woman has active in her body.

Measuring FSH level is what most doctors use to diagnose menopause. The FSH test does not measure estrogen levels it only confirms that a woman has stopped ovulating.

Estrogen is made from a variety of sources. The ovary is only one of many sources. Estrogen is available because hormones that are made by the adrenal gland can be converted into estrogen in fat, muscle and skin cells.

Estrogen is also available through food sources such as soy, and flax seed. We are exposed to many chemical substances in the environment that behave like powerful estrogens.

With the abundance of sources of estrogen available in the environment and the other sources available in the body, it seems unlikely that estrogen deficiency is the problem.

When accurate estrogen levels are obtained from the saliva we find that most menopausal women have normal or even elevated levels of estrogen.

(see Salivary Testing Page 5)

Menopause: Estrogen or Progesterone Deficiency

As we discussed earlier, FSH is commonly used by doctors to diagnose menopause. FSH is elevated when ovulation or egg production ceases. The hormone that is directly dependent upon ovulation is progesterone.

While estrogen can be produced from a variety of sources within the body and externally; progesterone is only produced after ovulation.

Estrogen and progesterone are produced together throughout the reproductive years and function best when they are produced in their normal balance.

Estrogen is produced prior to ovulation to replenish the inner lining of the uterus that was lost during the menstrual cycle. Progesterone causes the uterine lining and the breast to further develop to prepare for a possible pregnancy.

Estrogen and progesterone also effect other organs like the brain, the endocrine system , the immune system, etc. When these hormones are present in the normal levels they balance and counterbalance each others activity and do not cause any symptoms.

Progesterone and Menopause

During and after menopause ovulation ceases and so does the production of progesterone. Progesterone cannot be made from other hormones and it is not available in the environment in any significant amount. In order to maintain balance the body begins to make testosterone and other male hormones. This is why menopausal women begin to grow facial hair and develop male pattern baldness.

During menopause women may have normal or even elevated levels of estrogen while progesterone level is low or immeasurable. This imbalance of hormones, that are dependent upon one another for proper function , is more likely to be the cause of menopausal symptoms than estrogen deficiency.

Why is progesterone so important? Progesterone does more than just balance estrogen. Progesterone is vitally important to the normal functioning of several organ systems in the body. The functions of progesterone include using fat for energy, decreasing water retention, eliminating depression and anxiety, I improving mental function, increasing sex drive and increasing the effectiveness of other hormones like thyroid hormone, testosterone and estrogen.

A deficiency of progesterone can explain most of the symptoms of menopause. Hot flashes occur when the pituitary gland in the brain is attempting to force the the ovary to make its original amount of estrogen and initiate ovulation. When progesterone is available in the proper amounts the hot flashes decrease because the gland in the brain assumes ovulation is functioning normally since progesterone is around.

Mood swings can also be traced to progesterone deficiency or an estrogen excess. Progesterone has a calming sedative effect on the brain. It attaches to a receptor in the brain that decreases anxiety and elevates mood. This receptor in the brain is called the GABA receptor. The GABA receptor is the same receptor Prozac and other antidepressant and anti-anxiety drugs use to produce their effect on the brain.

Insomnia is another frequent complaint of women during menopause. The insomnia is probably due to the lack of the calming effects of progesterone. Replacing progesterone usually improves insomnia.

Many women complain of poor concentration and lapses in memory during menopause. Progesterone is involved with providing insulation to nerve cells. Myelin which surround nerve cells, acts like rubber around electrical wires. Myelin insulates nerve cells and improves conduction of nerve impulses. Decreased progesterone may interrupt the production of myelin and interfere with brain impulses.

Estrogen without the proper amount of progesterone can interfere with thyroid hormone function.Thyroid hormone is necessary to properly metabolize food and convert it into energy. If thyroid hormone is not functioning properly women experience weight gain, fatigue, food cravings and symptoms of low blood sugar.

What may be most disturbing to women is the loss of scalp hair and the growth of facial hair after menopause. Testosterone, the male hormone can be produced by the ovary and the adrenal gland after menopause. The body uses this hormone to balance estrogen in the absence of progesterone. This results in male pattern baldness and facial hair growth. Replacing progesterone usually reverses the process and initiates growth of scalp hair and stops facial hair growth.

Hot Flashes

If most women need progesterone why do hot flashes go away when women take estrogen? The body is reacting to a relative deficiency in estrogen. Even though most American women have normal to high levels of estrogen during menopause When the ovary stops making estrogen during menopause the body recognizes it as lower than normal.

In attempt to stimulate the development of an egg in the ovary, the pituitary gland becomes overactive. The pituitary gland tries to stimulate the ovary by releasing excessive amounts of FSH. The pituitary gland is adjacent to the area in the brain that controls body temperature. It is believed that the over activity of the pituitary stimulates the temperature center and produces hot flashes.

Estrogen replacement returns the estrogen level back to the level prior to menopause. The problem with estrogen replacement is that you are returning to a high level of estrogen with no progesterone. Progesterone actually decreases the amount of estrogen that is required to avoid menopausal symptoms. This is why women on estrogen replacement complain of side effects associated with too much estrogen. Breast tenderness, weight gain, bloating, fatigue, blood clots and increased breast cancer risks are all associated with excessive estrogen.

Replacing estrogen produces short term relief but can cause long term problems. This is probably why less than 20% of women remain on estrogen for more than one year.

Do I Need Estrogen?

Menopause cannot be simply explained by lack of estrogen. While estrogen deficiency may play a role in some women’s experience in most cases it does not.

Most women in America are over their ideal body weight. It is well documented that overweight women produce too much estrogen. Estrogen is made in fat cells. The estrogen that is made is called estrone. Estrone is a relatively strong estrogen.

Women who are overweight are at an increased risk of diseases that are known to be caused by elevated estrogen. Uterine cancer and breast cancer are more common in women who are overweight.

Also, women that are overweight are more likely to be diabetic. Women who are diabetic are more sensitive to estrogen than women who are not diabetic.

Estrogen also increases weight gain and makes it more difficult to lose weight. Women who are overweight should not take standard synthetic estrogen replacement.

Women that are not at risk for osteoporosis should not take estrogen replacement. Estrogen has two FDA approved indications. One is the relief of hot flashes the other is the prevention of osteoporosis in women who are at high risk.

If a woman is experiencing hot flashes soy and/or progesterone can alleviate the symptoms. Also, a herb black cohosh is helpful in some women.

Not all women are at high risk for osteoporosis. Women that have a thin frame, and of North European decent with extremely fair skin, sedentary lifestyle, history of smoking and prolonged steroid use are at risk for osteoporosis. Women not in this high risk group do not need estrogen to maintain normal bone health.

African-American women and other people of color are at very low risk for osteoporosis and should not take estrogen for osteoporosis prevention. Although very thin fair skinned African American women may be at risk.

Women that are overweight do not have to worry about osteoporosis. Osteoporosis is very uncommon in women over their ideal body weight if they have no other risk factors.

Another myth about estrogen replacement is that estrogen prevents heart disease. Estrogen does not prevent heart disease. There is no evidence that estrogen alone alters the risk of heart disease. This is supported by the FDA. So please don’t be persuaded to take estrogen replacement for the prevention of heart disease.

Saliva Testing

Saliva testing is the most accurate test to determine steroid hormones (i.e. progesterone, estrogen, DHEA and testosterone) levels .Saliva testing is much more accurate and useful than any blood test when attempting to determine who needs hormone replacement.

Steroid hormones are fat soluble. This means that they dissolve in fat or oil and not water. Oil and water do not mix. The body makes carrier proteins, that can dissolve in water, that attach to the fat soluble hormones. This allows the fat soluble hormone to travel in the watery bloodstream.

These steroid hormones that are attached to the proteins in the blood are not active. They are unable to bind to the cells because they are surrounded by this water soluble protein.

If we look at the hormone as a piece of that your taste buds can recognize. The candy wrapper is the protein surrounding the hormone and protecting the flavor of the candy or the message of the hormone. If we measure the amount of hormone or candy in the blood over 99% is wrapped. If we measure the amount of hormone or candy in the saliva we measure how much is unwrapped and delivers the flavor or the message of the hormone to the breast, uterus, ovaries, brain.

There are a number of factors that determine how much hormone, especially estrogen, is unwrapped and active in the body. Increased weight, diabetes, stress, low fiber , high fat diets can all increase the amount of estrogen that is unwrapped . If too much is unwrapped, estrogen will produce symptoms associated with too much estrogen. The total amount of estrogen in the blood can be normal or low.

Exercise, high fiber diets, eating the proper fats, eliminating stress, avoiding external estrogen, and eating soy, all decrease the amount of active estrogen in the body.

Because there are so many variables it is impossible to know what hormones are active without testing the saliva. Not only can saliva determine the amount of estrogen, it can also determine the active amounts of progesterone, DHEA, testosterone, and cortisol . All of these hormones levels may be altered by menopause.

Hormone replacement therapy is prescribed by many physicians recommend without utilizing an accurate test that confirms that the therapy is needed. However, millions of women have been placed on hormone replacement therapy despite significant short and long term side effects.

Saliva testing is available in several labs across the country, Some insurance companies are now covering the cost of the test. If your insurance company does not cover the cost, the test is about $150.