• Dr. Alla Arutcheva

Menopause – Natural biological process

Updated: Mar 15, 2018


Natural menopause happens gradually. The ovaries don't abruptly stop working, they slow down. The transition to menopause is called perimenopause that means "around menopause" and refers to the time during which your body makes the natural transition to menopause, marking the end of the reproductive years.

Women start perimenopause at different ages, as early as their mid-30s,-40s. You may notice signs of progression toward menopause, such as menstrual irregularity,


Hormonal changes


Ovaries are the major source of estrogen and progesterone during reproductive ages. Estrogen are also produced by adrenal glands, fat and other tissues [Labrie F, 2015].

When menopause is starting, the number of ovarian follicles declines and the two ovarian hormones—Luteinizing Hormone and Follicle-Stimulating Hormone no longer perform their usual functions to regulate estrogen, progesterone and testosterone production and ovarian estradiol secretion ceases.

At the time of menopause, the adrenal glands should produce sufficient estrogen and progesterone to avoid unpleasant menopausal symptoms. If the adrenal glands are depleted symptoms of menopause occur. So, optimal adrenal gland function is needed for a smooth menopausal transition.

The ovarian secreted estradiol releases to the blood flow, peripheral produced estrogens are inactivated intracellularly without a significant level in the blood, that why there is no reason to measure estrogen level in the menopausal period.


Symptoms


Natural decline of estrogen levels during menopause can significantly affect women health.

The level of estrogen rises and falls unevenly during perimenopause.

Throughout the menopausal transition women might experience:

  • Irregular periods. The length of time between periods may be longer or shorter, the flow may be light to heavy, and you may skip some periods.

  • Hot flashes (HF) and night sweat. Hot flashes are common during perimenopause. The intensity, length, and frequency vary.

  • Mood changes. Mood swings, irritability or increased risk of depression may happen during perimenopause.

  • Vaginal problems and changes in sexual function. When estrogen levels diminish, vaginal tissues may lose lubrication and elasticity become dry and making intercourse painful. During perimenopause, sexual arousal and desire may decrease.

  • Bladder irritation. This period is vulnerable to urinary infection and weakness of bladder and urethra that contribute to urinary incontinence.

  • Bone loss. The lack of estrogen contributes to the development of osteoporosis.

  • Heart palpitations. Heart palpitations are a direct result of lower levels of the estrogen.

  • Sleeping problem. Perimenopause and menopause affect sleep quality. Hot flashes and sweat may interrupt sleep that causes daytime fatigue.

Some women experience severe symptoms, others just tolerable or simply no symptoms.


Hot flashes


One of the common and stressful symptoms of menopause are hot flushes (HF), which occur quite often. The episodic sensations of heat, intense sweating and flushing can recur with varying frequency and intensity. Hot flushes are a heat dissipation response characterized by flushing and sweating, probably triggered by a narrowing of the thermoneutral zone in the hypothalamus [Kronenberg F., 2010] and an increased central secretion of noradrenaline [Babel R,2017 ]. Anxiety contributes to hot flush severity [Mitchell ES, Woods NF, 2015]..

The age at onset of HF is varying from woman to woman. Estrogens seem to interact with several neurotransmitters like norepinephrine, serotonin and endogenous opioids [Casper RF., Yen SS. , 1985: Berendsen HH. ,2000].


Rarely, high levels of circulating estradiol that is not balanced by adequate progesterone have often been attributed to estradiol-producing neoplasia, fibrocystic breasts, uterine fibroids and ovarian cysts in premenopausal and menopausal women. High level of estrogen in postmenopausal women is usually due to overuse of estrogen medications, supplementation or slow clearance from the body, because of sluggish liver function. High estradiol in premenopausal women is usually caused by excessive production of androgens (testosterone and DHEA) by the ovaries and adrenal glands, which are converted to estrogens by the ‘aromatase' enzyme found in adipose (fat) tissue.


Menopause and depression


A diagnosis of depressive disorder was 2 times more likely to occur in the menopausal transition compared with when the woman was premenopausal [Freeman EW, et al 2006].

It has long been recognized that women are at a higher risk than men to develop depression and that such risk is particularly associated with reproductive cycle events. The transition to menopause is associated with higher risk for new onset and recurrent depression. A number of biological and environmental factors are independent predictors of depression. It includes the presence of hot flushes, sleep disturbance, history of severe premenstrual syndrome, ethnicity, history of stressful life events, past history of depression, body mass index, socioeconomic status and the use of hormones and antidepressants [Frey BN. et al, 2008].

Menopausal transition and early postmenopausal years have been described as a "window of vulnerability" for the development of depressive symptoms or depression in some women. Estrogen plays an important role in mood and cognitive regulation [Soares CN., 2014].


Menopause and Cardiovascular diseases


Before menopause, women are protected from atherosclerotic heart disease associated with obesity relative to men. Women have a nearly decade-long delay in first myocardial infarction compared to men [Freedman DS. et al. 2004; Lloyd-Jones D. et al. 2009]. The higher level of estrogen in women before menopause protects against cardiovascular disease [Roger NH. et al. 2011; Wilmot KA. et al. 2015]. Naturally cycling estrogen has been proposed to be protective against atherosclerotic cardiovascular disease. This view is supported by the increase in cardiovascular disease risk in women seen after menopause, which involves a natural decline in ovarian hormone production. However, hormone therapy did not improve cardiovascular disease.


Estrogen and Liver function


Estrogens have effects in many organ systems that contribute to cardiovascular risk protection, including regulation of liver lipid metabolism and serum lipoprotein levels. The liver is an important site where fatty acid, triglyceride, and cholesterol metabolism are coordinated to meet body's metabolic needs.

Obese women have more fat under the skin, whereas men have more fat in the internal organs. With menopause body fat in women become accumulated not only under the skin, but also in the internal organs [ Svendsen OL.et al, 1995]. Two large prospective studies confirmed that body fat distribution predicts risk of future cardiovascular disease [Canoy D. et al. 2007; Yusuf F. et al. 2005]. Exercise and weight loss can reduce waist to hip ratio and reduce the risk of cardiovascular disease.


Natural help to premenopausal and menopausal women


Diet, exercise, nutritional supplements could relive the estrogen burden and symptoms naturally.

Diet should be balanced and contain an adequate amount of protein, carbohydrate, and fat.

Women's metabolism in the climacteric period slows down and women in their mid-forties tend to gain more weight. It is one of the most unpleasant menopause symptoms. The less weight you gain during menopause, the better your menopause symptoms in general, so it's worth adopting a diet of low sugar, balanced Omega 6 and Omega-3 fat, fruits and vegetables, whole grains, and lean protein. Food should provide the body with vitamins and microelements. Whole grains, such as steel-cut oatmeal, quinoa, barley, and brown rice, provide B vitamins, including folic acid and fiber.

Iron level decreases during menopausal years. Iron can be replenished by eating lean cuts of grass-fed beef, eggs, beef liver, spirulina, dark chocolate, and spinach.

By filling up on low-calorie fruits and vegetables, and controlling meal portions you can help to minimize weight gain and menopause symptoms.

Food to avoid and minimize: alcohol, sugar, excessive caffeine, and spicy foods.


Phytoestrogens


Adding phytoestrogens, or plant-based estrogens in diet might reduce symptoms of menopause. Major phytoestrogens are Isoflavones – present mainly in soy, chickpea, beans, and Lignans – found in flaxseeds, sunflower seeds, seed oils (mainly flaxseed oil).

Soy


Studies of phytoestrogens such as the isoflavones found in soy and red clover have had inconsistent results on relieving menopausal symptoms. There is controversy regarding usage of soy products. According to Knight DC et al., 2001 75% of women using the soy-rich diet reported bloating, sickness, body weight gain, and gastrointestinal disturbances, in contrast to the placebo group, in which these symptoms occurred in only 17% of women.

Another study showed that soy extract has a positive effect on vaginal pH in comparison to placebo [Bicca ML et al. 2009].

One study demonstrated a significant increase in the percentage of constipation and fractures in patients using soy extracts in comparison to placebo [Levis S et al, 2011].

The results of a few publications suggest a cancerogenic action of long-term soy consumption. Shike et al. 2014 showed that exposure to soy enhances the gene expression in the MCF7 cells of breast cancer, which may initiate the cancerogenesis. De Lemos, 2001 published a meta-analysis of studies published between 1966 and 2001, which revealed that soy even in low concentrations can stimulate the growth of malignant breast tumors in both an in vitro model and in animal experiments.

Endocrinologists state that phytoestrogens, including soy-derived isoflavonoids, result in inconsistent relief of symptoms. The guidelines advise that women with a personal or strong family history of hormone-dependent cancers, thromboembolic events, or cardiovascular events should not use soy-based therapies.

Suggestion based on research: Soy products should be limited. The best low processed soy product is tempeh.


Flaxseed


Flaxseed seems to be more effective as compared to soy in decreasing the frequency of hot flashes [Dalais FS et al., 1998 ]. Dodin S et al. 2005 found that night sweats decreased more efficiently in the flaxseed group as compared to the placebo.

However, the current systematic review showed that flaxseed increases estradiol level and may increase the risk of breast cancer [Hooper L et al., 2009].

On the other hand, there is an evidence for protective effect of flaxseed on breast cancer. A recent study by Lowcock EC et al., 2013 showed that ingestion of flaxseed with high concentrations of lignans, was associated with a reduced risk of breast cancer only in the postmenopausal period [Buck K et al., 2010]

Flaxseed and flaxseed oil can be used as a condiment, in salads, yogurt, oatmeal, smoothly approximately 1-1.5 TBS per day.


Food rich in calcium (Ca)


Because of the risk of osteoporosis food rich in Ca is recommended. Dairy products are considered good source Ca. However, if dairies are excluded from the diet, lack of Ca can be replenished by dark leafy greens, chia seeds, and almond.

Diet should not be deprived of proteins. Protein is required to carry protein-bound calcium into the blood. Insufficient protein-bound calcium lays the foundation for arthritis and other calcium deficient diseases. Why? When the blood cannot carry calcium because it lacks protein, it withdraws the necessary calcium from the bones to maintain homeostasis.


Deficiency of enzyme Protease can aggravate menopausal symptoms. Protease is recommended for women with PMS.


Pre- and menopause diet should be individualized according to person's symptoms and health condition. Some trigger foods (dairy products, hot spices) should be removed.


Resveratrol


Resveratrol has the characteristics to be an alternative therapy in the treatment of HF in the climacteric period [Leo L et al, 2015]. Resveratrol is a natural non-flavonoid antioxidant polyphenolic compound. Resveratrol exerts more evident effects when administered in combination with vit D [Uberty F. et al, 2017]


Black cohosh


Black cohosh has received more scientific attention for its possible effects on menopausal symptoms than have other botanicals https://nccih.nih.gov/health/providers/digest/menopause-science

Chung DJ.et al., 2007 and Briese V. et al. , 2007 showed the significant beneficial effect of the combination of black cohosh and Saint John's wort on the hot flashes. It was found that black cohosh and Saint John's wort (H. perforatum) combination had higher efficacy compared to black cohosh alone regarding hot flashes reduction.


Help with menopausal depression and anxiety includes meditation, yoga and herbal remedies to promote relaxation.


To ensure successful outcome treatment decision should be made after evaluation of woman's health condition, identification health problem and menopausal symptoms.

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