Evidence-Based Naturopathic Care for Menopause Hormones Support
Menopause Doctor in Ontario
Natural Menopause Hormone Therapy
Menopause Hormonal Shift Not Going Well?
Hormonal issues in menopause and perimenopause can be life-altering. All women transition to menopause, but some women suffer in the process. There are natural menopause treatment options to help balance hormonal health, improve day-to-day symptoms, as well as prevent long-term medical conditions.
What's the Difference Between Menopause and Perimenopause?
What is Menopause?
Menopause is a natural biological process that marks the end of menstruation and fertility in a woman’s life. It typically occurs in the late 40s to early 50s (average age of 51), although it can vary for each individual (the range is anywhere from the 30s for premature ovarian failure to the 60s). During menopause, the ovaries gradually produce less estrogen and progesterone, leading to the cessation of menstrual cycles.
It is when the ovaries close up shop. They have done their part, and now they are entering retirement. Very few mammals experience menopause, and there is a theory that this is an evolutionary strategy to improve intergenerational survival. When one door closes, another door opens. Stepping into the menopausal phase of life can be a beautiful, liberating, and nourishing experience. However, there are some physical and emotional symptoms that may make this process challenging for some. Getting the right assessment and care to ensure that you are feeling your best at this phase of life is not only important for today and tomorrow but also for setting you up for a healthy elderly phase as well.
What is Perimenopause?
Perimenopause is the transitional phase that precedes menopause. It can start several years before menopause and is characterized by hormonal fluctuations. During perimenopause, women may experience irregular periods, as well as the onset of various menopausal symptoms.
Just as the turning on of ovarian function is not always a smooth process (i.e., turbulent teenage years), the ovaries tend to spit and sputter on their way out as well. It is not always a smooth linear decline to menopause. Once women start to miss ovulations, there are step-change decreases in progesterone levels, and it is the scheduled periodic increase and subsequent decrease in progesterone that keeps estrogen levels in check. So, during the transition to no ovulations and no periods, there is often a phase of unpredictability in menses, as well as in mood, sleep, energy, breast tenderness, and many more symptoms that can occur.
Our team-based approach to patient care
Risk Factors that Increase After the Menopausal Transition
Female hormones are extremely protective against various chronic diseases. For example, once a woman has transitioned to menopause, her cardiovascular risk increases to match that of her male counterpart. Additionally, without the bone-stimulating effect of estrogen, bone density declines once menopause begins.
There are many dietary, lifestyle, and supplemental measures we can take to reduce the risk as much as possible, and it may be appropriate to consider the use of bioidentical hormones to extend the protective timeline against some of these diseases. As part of our thorough menopausal work-up, we ensure that we have screened for these chronic diseases and calculate your risk to help you make an informed decision about which intervention is most appropriate for your specific case.
Common Hormonal Symptoms of Menopause and Perimenopause
Menopause and perimenopause can bring about a range of symptoms, which may vary in intensity and duration for each woman. Some of the most common symptoms include:
Hot Flashes and Night Sweats:
Hot flashes are sudden sensations of intense heat that can cause flushing and sweating. Night sweats are similar but occur during sleep, leading to disrupted sleep patterns.
Mood Swings and Emotional Changes:
Fluctuations in hormone levels can contribute to mood swings, irritability, anxiety, depression, and difficulty concentrating. Brain fog is a common symptom that we see in our patients. Brain fog usually improves on its own after the perimenopausal transition, but hormonal balancing (including the use of bioidentical hormones) can greatly improve brain fog during perimenopause.
Vaginal Dryness and Discomfort:
Decreased estrogen levels can lead to vaginal dryness, itching, and discomfort during sexual intercourse, which may affect a woman’s quality of life and intimate relationships. This symptom is almost universal in postmenopausal women. There are some natural lubricants that can be helpful, and pelvic physiotherapy also has utility, but the most reliable and effective treatment for this is the use of bioidentical estrogen (topical estriol, in particular).
Sleep Disturbances:
Many women experience difficulties with sleep during perimenopause and menopause, including insomnia, waking up frequently during the night, or having trouble falling asleep. Though we have to first ensure that the patient’s nutrition is not a contributing factor (low-calorie and low-protein intake in the evening can contribute to nighttime cortisol spikes, which trigger wakefulness), as well as rule out sleep apnea or a urinary concern, bioidentical progesterone can be very useful for perimenopausal and menopausal insomnia.
Changes in Menstrual Cycle:
During perimenopause, menstrual cycles may become irregular, with variations in the length of the cycle or the amount of flow. Eventually, menstruation ceases altogether in menopause.
Changes in Sexual Function:
Some women may experience a decrease in libido or changes in sexual desire and satisfaction due to hormonal fluctuations and vaginal dryness.
Clinical Intake
The first visit with one of our naturopathic doctors is up to 90 mins! This is so long because you are complicated and it usually takes that much time to hear your whole story. We need to ask you about your sleep, energy, mood, food choices, digestion, exercise, stress, etc. We need to take the time to look into all of the nooks and crannies and not miss a detail, as so often there is one tiny clue that really pulls the whole case together.
Lab Testing
Symptoms alone are often not enough to guide a proper treatment plan. Having a good look “under the hood” by testing either the blood, urine or saliva for estrogen, progesterone, testosterone, DHEA and cortisol, among other labs can be invaluable for determining the root cause of a woman’s concerns. We also need to rule out any other non-hormonal issue, to ensure that your foundations of health are well set up. This includes looking at your iron, B12, vitamin D levels, thyroid, cholesterol, liver and kidney markers, inflammation, blood sugar and insulin, etc. We also often draw from data collected by wearable medical devices and fitness trackers (like continuous glucose monitors, Oura rings, Apple watches, Fitbits, Garmins, etc). The more data we get, the more precise and effective the treatment can be.
Diagnosis
Naturopathic doctors are some of the few regulated health care providers in Ontario that are legally capable of diagnosis. Diagnosis is a protected act and only entrusted to highly trained medical professionals regulated by governing bodies that ensure the safety of the public.
Treatment
A Naturopathic Doctor works with you to create a strategy for improving diet and reducing stress, and we also create a plan to level the hormonal playing field often using herbs, acupuncture, supplements, bioidentical hormones, etc. These add-on therapies are usually required short-term to bring you back to balance, and then the lifestyle and dietary modifications continue long-term to hold you in a state of good health.
Getting started:
Lab Testing In Menopause
Comprehensive Evaluation: Assessing Hormonal Health and Well-being
Diagnosis of menopause is actually based solely on the absence of a period for 12 or more months. However, laboratory testing is important to assess your overall health and determine which intervention may be safest and most effective for you.
Lab Tests in Menopause and Perimenopause
General health testing: CBC, iron panel, CRP (inflammation), B12, vitamin D, fasting insulin, HbA1C, cholesterol, liver enzymes, kidney panel, thyroid, and urinalysis. If you have a family history of heart disease or an issue with methylation, we may also test your homocysteine, and if you have a personal history of high cholesterol, we may run an LDL particle test.
Hormone Panel Testing: Unveiling Hormonal Imbalances
Testing your estradiol is important, as some women who have not had a period in many months can still have medium or high levels of circulating estrogen. Before we feel comfortable prescribing bioidentical hormones, we need to know that the levels are low and it is safe to do so. We may also add in progesterone, prolactin, testosterone, and DHEA if appropriate. FSH rises in menopause, so we will test this as a marker of ovarian function.
Public Health Screenings in Menopause: Assessing Overall Health
It is particularly important to stay up to date on health screenings once you reach menopause. In Ontario, our public health system is excellent at keeping individuals (even those without a family doctor) informed about when they are due for their updated tests.
- Bone mass density testing
- Colon cancer screening
- Breast cancer screening
- Cervical cancer screening
It’s also important to stay up to date on your vision and hearing tests, as well as blood pressure testing (which can be done at your local pharmacy).
Hormone Supplements In Menopause
Depending on the individual, there are many supplements and herbs that can be appropriate for improving symptoms. These can include omega-3, probiotics, DIM, black cohosh, vitex, soy isoflavones, calcium, magnesium, vitamin D, vitamin K, and many more. It’s best to see your naturopathic doctor to get a personalized list of supplements that are right for you. Often, new patients arrive already taking handfuls of supplements, and part of what we do is to teach them how to get many of these nutrients through their diet and only take the supplements that are needed.
Nutrition for Menopause and Perimenopause
As with any stage of life, eating a healthy diet is integral to optimal health. In perimenopause and menopause, there are some additional things to consider:
Bioidentical Hormones In Menopause
There are two ways to use bioidentical hormones:
- To top up and balance fluctuating hormones
- To replace declining hormones
For this reason, it is called “Menopausal Hormone Therapy,” and the specific dosing and ratio not only varies per patient but also varies depending on where the woman is in her hormonal transition. Licensed naturopathic doctors prescribe estradiol, estriol, and progesterone. It can be dispensed as a patch, a gel, a cream, or a capsule. There is a complicated history about the safety and efficacy of hormone replacement therapy (more about that in an upcoming post), but the takeaway is that for most women, as long as they have been properly screened and the prescription is the right dose and combination, it is safe for up to 5 years and potentially for up to 10 years. Like all medical choices, it requires a thorough risk-benefit analysis of all the variables that pertain specifically to you. Our naturopathic doctors take the time to do a thorough screening process, provide you with education about the research, and give you the time you need to ask all your questions so that you feel fully informed and comfortable about your decision.
IS HORMONE THERAPY RIGHT FOR YOU?
Many people have a lot of uncertainty around hormone therapy due to widespread dissemination of the negative results of some older research, but in fact, newer evidence shows that not only can hormone therapy be safe and symptom reducing in certain populations, but actually reduces some chronic diseases as well.
Take 1 minute to complete this FREE SELF TEST to determine if you are possibly a good candidate for hormone therapy.
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We serve naturopathic patients all across Ontario!
Our service area includes:
Ottawa | Toronto | Hamilton | Kitchener | London | Oshawa | Windsor | St. Catharines | Barrie | Guelph | Kingston | Milton | Brantford | Thunder Bay | Sudbury | Peterborough | Belleville | Sarnia | Sault-Ste-Marie | Northbay | Cornwall | Timmins | Carleton Place
… And all small towns and rural areas in between! As we offer virtual appointments, our naturopathic patients have the flexibility to see us from the convenience of their home or office. And we rely on local laboratories (Lifelabs and Dynacare) to complete the testing required to do a complete assessment.