The more menopause is studied by medical professionals, the more we learn about how long it can present in women and how many dismissed or misguided symptoms are actually a result of going through “the change.” This has sparked a blend of frustration and relief, new answers, but also more questions, and an onslaught of potential menopause management solutions. And, while we’re thrilled to witness a growing global conversation on menopause and normalizing it in our society, there’s still so much more that needs to be studied and too many women who are suffering in nearly every area of their lives when menopause comes knocking on their reproductive door.

As two 50-something women, we’re on a mission to uncover as much as we can about menopause and bring our findings to you in a way that’s easily decipherable and informative enough for you to explore for yourself. Maya and I are determined to feel and look our best in the second half of our lives, and we’re confident you feel the same way. This post is the first of a series that can help us understand this dragon we call menopause. What we know so far is the solutions and treatments for menopause can be overwhelming. The process of finding something that works typically involves a lot of trial and error, and there can be just as many factors triggering the issues as there are treatments available.

By the end of this post you should have a better understanding on the difference between peri-menopause and menopause and how the three female sex hormones factor in the progression of menopause. We’re also sharing parts of a conversation we had with a functional medicine doctor and her approach to treating menopause.

What is Functional Medicine?

What is a functional medicine doctor and how can they help me with my hormones? Functional medicine is a form of alternative medicine which focuses on the "root cause" of disease by diving deep into the patient’s history, environment, lifestyle, and biochemistry to determine what is causing the illness. The goal is to identify imbalances that may lead to disease and to restore maximum function between all physiologic functions of the body. According to the Institute for Functional Medicine, “Perimenopausal and menopausal women are a large demographic group who may benefit from this approach, with each woman presenting a unique hormone profile, health history, and wellness path.”

Unlike traditional doctors, who might prescribe prescription medicine or surgical procedures as a primary treatment plan, functional medicine doctors first look to improve things like diet, exercise, sleep, and stress reduction. They may also use methods such as naturopathy, acupuncture, or detoxification when treating their patients. You may be asking, are functional doctors real doctors? Yes, functional medicine doctors (MD or DO), have to complete traditional medical school training before attaining additional certification from an accredited functional medicine program. They can prescribe all forms of medicine if and when necessary which is ideal for a woman suffering from menopausal symptoms who would like to consider HRT in addition to natural and alternative treatment methods. The Institute for Functional Medicine explains, “tailored interventions may help alleviate symptoms and reduce long-term health risks associated with menopause by addressing any underlying issues that are known to contribute to hormone imbalances. Interventions may include nutraceutical and lifestyle treatments, hormone replacement therapies, or a combination of approaches.” Every patient’s medical profile is unique and tailoring a treatment plan specifically for them is key to a functional medicine doctor’s process. For women going through menopause, the process involves looking at three key hormones that diminish in production as they age, triggering a storm of unbearable symptoms.

Peri-menopause, Menopause and Female Sex Hormones

A woman’s body produces three sex hormones: estrogen, progesterone, and small quantities of testosterone.  Estrogen and Progesterone are commonly thought of as sex or reproductive hormones.  Estrogen is essential for reproduction, but it also plays a role in the regulation of many non-reproductive organs and systems of the body.  Cells in the vagina, bladder, breasts, skin, bones, arteries, heart, liver, and brain all contain estrogen receptors, and require this hormone to stimulate these receptors for normal cell function.  Estrogen keeps the skin smooth and moist, and it keeps the body’s internal thermostat operating properly.  It’s also necessary for proper bone formation.  Progesterone acts as a counterpart to estrogen.  During the second half of the menstrual cycle, it stimulates changes in the lining of the uterus to complete its preparation to act as a “home” for a fertilized egg.  Progesterone also has effects beyond the reproductive system.  It has a calming effect on the brain and affects others aspects of the nervous system.  And then there’s Testosterone. It’s produced in small quantities in a woman’s body and helps regulate bone density, muscle mass, cognitive function, mood, sexual function, and energy.  When all three hormones are in balance, a woman can feel and operate at her very best.  But after a certain age, a woman’s hormone production starts to decrease, and some noticeable and unwelcome changes start showing up and, over time, can continue to increase and evolve.  This stage is known as peri-menopause. 

Peri-menopause is the period when a woman’s body is preparing for menopause.  Hormone production, in the form of estrogen, progesterone, and testosterone, starts to slow down, usually in a womans’ thirties, and continues to diminish as they age.  Perimenopause can begin in some women in their 30s, but most often it starts in women ages 40 to 44.  Women may experience a variety of symptoms during this time, including (but not limited to) anxiety, dry skin, fatigue, bloating, headaches, heart palpitations, hot flashes, irritability, low sex drive, brain fog, loss of concentration, mood swings, night sweats, urinary incontinence, vaginal dryness, weight gain, cold hands and feet, joint pain, hair loss, and skin changes.  Each woman’s experience with peri-menopause varies and can last anywhere from 10-30 years (sigh!). And all of this crazy nonsense leads to the final phase of the journey:  Menopause.  

Menopause is the time when a woman stops menstruating altogether (woo hoo, finally, an upside to this ride ladies!). Menopause can happen naturally, or surgically.  Surgical menopause occurs after an oophorectomy, a surgery that removes the ovaries, which are the main source of estrogen production in the female body. Natural menopause happens when a woman stops producing hormones and menstrual periods stop (usually confirmed once a woman hasn’t had a period for 12 months)  By the time a woman has reached menopause, most of the acute problems are over, but some women may experience symptoms for longer.  This is also a time when women become vulnerable to other, serious health issues.  Over the long term, the diminished supply of estrogen increases the likelihood of cardiovascular disease, osteoporosis, and vaginal atrophy. 

Understanding of how female hormones work, and the different stages and symptoms of menopause are important for you to best navigate the solutions and medical path best for you. Functional medicine may be that right course for you.

Balancing Hormones & HRT - A Functional Medicine Approach

Once peri-menopause or menopause starts, women are often faced with the decision to opt into some kind of hormone replacement therapy to help balance their hormones and ease uncomfortable symptoms.  And if you’re a woman going through “the change,” achieving the optimal, hormonal balance day-to-day can be complicated if not completely frustrating.  At times it can feel like you’re a prisoner in your own body - unpredictable periods, uncontrollable mood swings, headaches, weight gain, fatigue, insomnia, hot flashes, night sweats, fatigue, anxiety, depression, bone loss, hair loss, and more.  It can be overwhelming, and, like our DNA, every woman’s experience is unique.  If left untreated, these awful symptoms can last for over 30 years!  Depending on where you are in your journey, a functional medicine doctor can help determine when you can start hormone replacement therapy (HRT) using an array of lab results, your medical history, genetic testing, diet and eating habits, plus other tools.  Some forms of hormone treatment can start during peri-menopause while others aren’t usually recommended until menopause starts.  Whether it’s HRT with progesterone only, with estrogen and progesterone combined, or estrogen replacement therapy (ERT) only, a functional medicine doctor can help guide you to the best solution for your body.

Many women who are suffering from symptoms of menopause consider hormone replacement therapy to help with their symptom relief. Learning about different HRT options can be a little confusing at first. We asked Dr. Camille Vardy, a functional medicine doctor with over 30 years experience in treating menopause, to weigh in on the topic.  “Any of these issues is a reason to seek out HRT as long as it is the right kind of HRT. That means bio-identical hormones in the right amounts, balanced properly with each other.”  Dr. Vardy applies a comprehensive, multi-layered, and natural approach when treating the root cause of her patients’ menopausal symptoms. After a thorough consultation and discovery of her patient’s medical history, current health, and symptoms, Dr. Vardy will order and review her patient’s labs in the form of blood tests and other genetic tests. As a functional medicine doctor, she is trained to look for data in their lab and test results that indicate specific hormone levels, nutritional deficiencies, microbiome health, and environmental toxins that could be contributing to their symptoms. This holistic, detailed data is crucial to helping Dr. Vardy identify the root causes of any issues/symptoms and prescribe the proper botanical supplements, diets. HRT treatments, and other treatments for each patient.

Generally speaking, there are two types of hormone replacement products available:  bio-identical and synthetic.  Bio-identical hormones are derived from plants, and most closely resemble hormones made by the body.  Synthetic hormones are produced by synthesis where manufacturers synthesize estrogen and progestin using animal by-products but are less similar to the body’s own estrogen.  There are differing views on whether or not bio-identical hormones are safer than synthetic hormones and the answer hasn’t been scientifically proven on either side of the debate.  As with most functional medicine doctors, Dr. Vardy is a proponent of bio-identical hormone treatments, stating “synthetic hormones are highly carcinogenic and even bio-identical hormones taken in the wrong doses can be problematic. So while synthetics may be common and while working with over-the-counter products may be popular, consulting a knowledgeable professional is always best.” If you’r unsure of your stance on the topic of bio-identical vs. synthetic hormones, the best thing you can do is your own research and use reliable, trustworthy sources. The one thing that was not refuted in our research is that bio-identical hormones are chemically identical to those a woman’s body produces naturally (estradiol).

Estradiol is the dominant form of estrogen produced by a woman’s ovaries.  Estradiol can be reproduced in the form of bio-identical hormones, and is available for replacement therapy under a variety of brand names.  It can be taken orally, applied as a cream, or absorbed through skin patches.  There are also synthetic versions of estrogen that may be prescribed.  Premarin is the synthetic estrogen most prescribed for HRT.  Estrogen dominance is important to understand if you are perimenopausal and thinking of hormone replacement.  Estrogen dominance can happen when the balance between estrogen and progesterone is not maintained.  Symptoms of estrogen dominance can include low energy, bloating, weight gain, and mood swings.  It can also increase certain types of cancers, including endometrial cancer.  This is why, unless you have undergone a hysterectomy, HRT regimens usually include both estrogen and progesterone. 

On of our biggest unknowns about HRTS is how long a woman can be on HRT. Dr. Vardy put it this way, “Once the hormones are balanced, the real question is not how long someone needs to be on it, but how long do we get to be on it? How long do we want to continue to enjoy a good sex life? Youthful vigor, muscle tone and flexibility? Lustrous skin and hair? A good mood? So many people are seeking the fountain of youth and healthy hormones are a key part of that. Compare a 30 year-old to a 60 year-old and the answer is clear, can I take this forever?”  Is Dr. Vardy a mind-reader too? We would love to feel like we’re in our 30’s again! And as women who are going through the “change”and haven’t consulted with a functional medicine doctor yet, she has our attention!

Additional Considerations

It is important to note that in addition to a woman’s hormone production decreasing as she gets older, women should also understand the role that diet, exercise, and environment can have on hormonal balance, and imbalance.  In all of our discussions with Dr. Vardy she stressed that a perfectly prescribed HRT treatment won’t work effectively if a woman’s diet and environment isn’t healthy or “clean.” She shared that if a woman is consuming foods laced with antibiotics, growth hormones, pesticides, GMO’s, or other harmful substances, they most likely are contributing to her menopausal symptoms. Most women aren’t aware of the chemicals present in a lot of the foods they eat or products they use, so it’s important to read labels and do research on ingredients to avoid any of these harmful substances. A list of the most common endocrine disruptors and their sources can be found here. Lack of exercise or not enough regular exercise can also contribute to symptoms. “Most critical to understanding hormones is that we’ve normalized and taken for granted that PMS, menopausal symptoms, post-partum depression and similar issues are a part of being a woman. It is simply not so. There are many reasons, related to diet and environment, that these things occur,” Dr. Vardy says. Her approach to treating her patients is all about balancing hormones while simultaneously incorporating a healthy diet and exercise regimen, and detoxifying your environment from plastics, foods, and other sources that contain harmful endocrine disruptors. Once this is achieved: energy returns, inflammation reduces, sleep restores, metabolism boosts, moods stabilize, brain fog lifts, and hot flashes are history.

Summary

Functional medicine, also known as alternative medicine, is a systems biology–based approach that focuses on addressing the root cause of disease and identifying triggers that are disrupting their gastrointestinal, endocrine, and immune systems. It utilizes the most current scientific knowledge regarding how our genetics, environment and lifestyle interact as a whole system to diagnose and treat diseases based on patterns of dysfunction and imbalance. And because menopause is all about the imbalance of hormones and dysfunction of a woman’s body, consulting a functional medicine doctor is an ideal option for women suffering from menopausal symptoms. The key takeaway is that there isn’t a silver bullet strategy to menopause from a functional medicine perspective. It requires patience, asking the right questions, ordering a variety of labs and tests, and a combination of conventional and non-conventional treatment methods to achieve optimal results. In Dr. Vardy’s experience, a balanced prescription of bioidentical HRT, healthy diet, regular exercise, and the elimination of disruptive environmental toxins are the keys to balancing hormones. And judging from our discussions with her, she is living proof that women can overcome menopause and thrive.

XOXO ~ Penny and Maya

For more information on Dr. Camille Vardy please visit:

https://www.camillevardy.com 

Healthy Wellthy U Podcast

https://www.linkedin.com/in/camillevardy

To Listen to our WERTH The Listen podcast interview with Dr. Vardy click here