Women have been saying it for years, and we HEAR you. There is more to menopause than hot flashes.
Women's Health Connection recognizes that all the endocrine and hormonal systems are interconnected, and when one hormone system dysfunctions, there is a domino effect. Another must try to compensate, but can't always, quite.
Your late forties and fifties should be the best years of your life. Yet for many women, the sleep disturbance, mood change, memory loss, skin change, headaches, weight gain, urinary symptoms, lack of libido, exhaustion, tearfulness, water retention, gastro-intestinal disturbance, vaginal dryness, and yes, sometimes hot flashes and nightsweats too, can be disabling.
Women's Health Connection recognizes that mending the problem(s) is not as simple as pulling out a prescription pad and writing a script for hormone replacement therapy. Hormones can have some serious risks, particularly if we are “replacing” hormones that you already have in more than adequate amounts. For example, many women who are overweight already have plenty of estrogen, because adipose tissue produces estrogens in large amounts long after the ovaries stop making it. Their menopausal symptoms may be happening because of lack of progesterone or adrenal hormones, or because the adrenal hormones are being undersecreted to compensate for insulin resistance. If we replace with “traditional” HRT, which is often a synthetic compound far different from anything your body actually produces, we have now given you too much of a potentially cancer-inducing hormone and not corrected the underlying problem.
Weight has an influence here. If your weight is up, it is important to realize that your adipose tissue (fat) does more than store energy. The fat, particularly the visceral fat, is also a dysfunctional endocrine organ that makes estrogen, but doesn't make progesterone. It also makes you more insulin resistant, and has fat storage influences. So you get in a vicious cycle. One of the reasons we measure estrogen levels before starting estrogen containing therapies is that many women already have more than enough estrogen on board, and treating menopause often involves bringing estrogen levels down if they are high, and bringing up the levels of other hormones that can affect hot flashes and menopausal symptoms if they are low. Everyone's genes and body composition are different, as well as their metabolism, so it's important to measure and know what we are dealing with in order to provide optimal care.
So instead it is important to measure what the body is doing because every woman's menopausal experience is different, and every woman's hormonal needs are different. If a potentially dangerous hormone, such as estradiol, is too high, there are ways to bring it down, and help shift the balance toward weaker estrogens, such as phytoestrogens, to compete with it, so it has less potential to do harm. It is important to replace deficiencies, but the goal should be only to replace them to the physiologic level, not higher. Looking at the full spectrum of menopausal hormones, not just the ovarian hormones is critical. Every hormone system interacts in many complex ways with every other.
Debra Ravasia, 2010, last updated 2017