Menopause: The Second Puberty

            There are 3 dramatic hormone changes in a women’s life: puberty, postpartum, and menopause. However, puberty and postpartum are often discussed and menopause seems to remain a “taboo” change to discuss, even amongst women. This needs to change because women spend more time in their “infertile” years than their fertile years. This is true for two reasons, first the average age of menopause is in the early 50’s and women are expected to live into the 80’s, second the hormones of menopause are the same as prepuberty which adds to the total number of infertile years. The puberty transition and menopause transition are both a set point change in the body and brain, and they almost mirror one another.  While there are differences, the same understandings can be made. We will learn more about the perimenopausal transition and menopause here.

            Let me start by saying…. menopause is a normal and expected process, however this transition being miserable…. even though common, IS NOT NORMAL. While our bodies experience a lot of change, many of the outward symptoms are warning signs of deep-rooted imbalances. Let’s start with the hormone changes and build from there. As you can see from the diagram below, the hormone transition of puberty and menopause are close mirrors of one another. There is a gradual change in both estradiol and progesterone (the sex hormones) from one set point to another. You can also see that it takes several years for this to occur, on average both processes are about 10 years in duration. In both cases the hormone changes in that window are temporary, meaning once they stabilize to their new set point, they are mostly balanced. Now look specifically at the perimenopausal hormones, progesterone begins to drop beginning around age 35. This transition happens in a smooth and steady manner. Progesterone is produced from ovulation to sustain the second half, or luteal phase, of your menstrual cycle (for more on this see the menstrual cycle blog). As we reach the perimenopausal window we innately have fewer eggs and ovulation begins to “skip”, when this happens there is less progesterone made. Progesterone also helps regulate the effects for estrogen. Estrogen is responsible for thickening the lining of the uterus in the luteal phase (second part) of the cycle. When there is this change in the balance of progesterone and estrogen, the lining of the uterus becomes thicker and can lead to, not only irregular cycles, but heavier menstrual flow. The decline of estrogen is not as smooth as progesterone, though. Estrogen is very sensitive to the signal from the brain called FSH (follicle stimulating hormone- or “make an egg” hormone). So as we begin to ovulate less, the hormones decline, and the pituitary gland, in the brain, begins to increase how much FSH it singles to the ovary, to force ovulation. When this occurs, we get an increased production of estrogen, then the signal slows and estrogen drops, repeat over and over and you see the up and down changes in estrogen. But estrogen does not act alone, there are several other compounds, like serotonin, which is responsible for mood and melatonin production (or sleep), that fluctuate with estrogen. This is where the hot flashes, night sweats, and mood changes come in. When we have such an intense drop in estrogen, these symptoms arise. This metabolic fluctuation also impacts the other “neighboring” systems including the pancreas, thyroid, and adrenal glands. These organs make other hormones like insulin, thyroid hormone, testosterone, and cortisol. This is where some of the blood sugar regulation, weight fluctuations, and cravings come from.

Now this is not a “doom and gloom” process, remember it is natural and essential. Here are the good changes that occur during this time: after the period of hormone fluctuation, menopause (12 months without period) is reached, and the new set point stabilizes. This stage has less calorie and energy requirements, constant, stable hormone supply, and therefore overall predictability of the body. This predictability your body knew as a child, but not since, so relearning it takes time. As our hormones change, we need to adapt our lifestyles, no different than puberty and postpartum. The problem here is that were not commonly taught about the metabolic changes that occur, like decreased energy requirement (ie food intake), so often women will gain, undesirable, weight.  

            What happens when symptoms or issues arise in this process? When our bodies are out of balance before this transition, there will be innately more symptoms. Your body requires a lot of resources and energy to make your menstrual cycle and metabolic processes occur during the fertile years, and this leaves many… if not all women, out of metabolic balance. By this I mean, we see vitamin deficiency, gut imbalance, and insulin resistance prior to starting this transition. When we start in the negative…. we go further in the negative during hormonal changes. So, the best way to “manage” the impending changes, is to optimize your overall health with good diet, exercise, vitamin replacement, and sleep. If you are already into the transition, it is not too late though, there is no better time than now to start healing your body from a deeper level. Here’s where to start.

Always focus on diet first, if you have not read my Gut Reset blog or Guide to Health, this is a great time.  We need to focus on real, whole foods, and eliminate or severely moderate as many ultra-processed, or fake, foods as possible… unfortunately, this also includes alcohol. You should prioritize protein and fat, and get carbs that come from veggies and fruit, and not the simple and ultra-processed ones that come from crackers, pasta, bread, and beverages. By doing this you give your body all the building blocks it needs to begin to heal the gut and promote balance for all these metabolic processes. Also remember, the change in hormonal set point, results in a lower energy requirement, meaning we need to intake fewer total calories for the day. While I say this, I do not want anyone to follow the “1200” calorie diet…. no diet that is blanketed to all people will work; you have to play with it. Most women, even in menopause, need a minimum of 1200 calories just for your heart to beat. If you eat too few calories you will go into “starvation mode” and this will continue to worsen the overall metabolic health. Second, you must prioritize sleep. This is when the body heals and repairs, you need to get 8 hours of restorative sleep. This might mean sticking to a regular schedule, going to bed earlier, and changing your bedtime routine. Third, you need to move your body, I know this seems hard, especially if you experience fatigue, but it will help your sleep and mood, promote muscle stability, help with the slowing metabolism, and ensure bone health. Moving does not need to be as wild as starting crossfit, simply waking with purpose, 30 min a day after dinner, will do.

             But what do we do after all of that and there are still symptoms? If, after that, you are continuing to have undesirable symptoms, you should consider seeing a medical provider to check hormones, vitamins, minerals, thyroid, and insulin regulation. You can start by adding in a methylated multivitamin, vitamin D replacement, and an electrolyte replacement. This will cover most of the common imbalances. Three other things you add in or try (for no less than 3 months) are fasting, specific supplementing, and replacing hormones. Fasting can be helpful in dealing with the change in energy intake and output. With fasting I encourage you to play with it, but overall, you should have an eating and non-eating window. This will help to promote insulin and blood sugar regulation, as well as help the gut repair itself and other organs. During your eating window focus on protein and fat first, they promote a full gut and are the only essential macronutrients, carbs can be made from both so we do not NEED high intake of extra carbs. I find the easiest window to fast is overnight. For example, stop eating 2 hours before bed, and don’t begin eating until at least 12 hours later. After you have mastered this, you can slowly increase up to 18 hours of fasting. I highly recommend you read Dr. Mindy Pelz “The Menopause Reset” for more info on this. As for supplementing specific deficiencies, this is where we need a medical team. Have all your vitamins and minerals checked and supplement for those areas. Common issues I find in practice include, but are not limited to vitamin D, zinc, iron, B vitamins, and potassium deficiency. Finally have your hormones checked. This includes, thyroid hormones, sex hormones, and pancreatic hormones, like insulin. The way to optimize these might mean a SHORT-TERM replacement plan. I say short term because, remember, this process is temporary and once the new set point is reached you often will not need hormones long term. Also remember, this process affects the whole body, which means symptoms might be multifaceted. For example, hot flashes could be your estrogen, thyroid, or blood sugar and heavy menses could be from low progesterone, thyroid, or blood sugar imbalance. This is why “one size fits all” does not work, each body needs different things.

            If you have more concerns, don’t have a provider, or just have questions about this process, please reach out! I have a supplement catalog in the links, or you can sign up for full scripts and I can customize a routine for you. I also help women, just like you, through this process every day, and we can make it a smoother transition.

Until next time, remember, thriving in health is about finding the balance that works for you at any given time.