Discover how to have a better menopause, starting now...
If you’ve landed on this page, it might be because you’re experiencing perimenopausal symptoms.
Menopausal symptoms can negatively impact your life in a significant way, and if you want to learn how you can better manage or resolve your symptoms, this article is for you.
We’ve worked with hundreds of women who are going through menopause, and we understand that it can be a really difficult time both for you, and for those around you.
It doesn’t have to be this way though, and with the Coho Functional Medicine approach to menopause, you can take control of your hormones and make your experience of menopause better.
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In this article, we’ll help you to discover how to be prepared, and what to do so you can sail through this natural transitionary period.
Since most women (85%) experience menopausal symptoms (1), it has become the norm, rather than the exception, to feel the effects of fluctuating and declining hormone levels.
Menopause is inevitable for all women and can cause significant mental, emotional, and physical symptoms.
Symptoms can be frustrating, unpredictable, and if we’re being honest, for many women, the symptoms feel totally overwhelming (to the point that some women feel suicidal) and life-changing (not in a good way).
It’s therefore unfortunate that there is so little support from conventional medicine.
In conventional medicine, symptoms are managed with synthetic hormones, and associated conditions such as high blood pressure, or high cholesterol, are treated with medications.
This doesn’t aways have the desired outcome.
There is a better way, through a Functional Medicine approach to menopause.
Your menopausal years don’t need to take over your life leaving you feeling miserable and hopeless.
What is the menopause?
Menopause marks the end of menstruation and medically, is defined by the absence of a menstrual period for one year. (2)
Menopause usually occurs between the ages of 45 and 55 (3), and the average age in the UK is 51. (4)
The period leading up to menopause is the perimenopausal period, and then once a whole year has passed since the last menstrual period, women enter the postmenopausal period.
Perimenopause encompasses the gradual change in ovarian function, and this period can last from anywhere between 6 to 13 years. (5)
During perimenopause, ovarian hormone levels start to first fluctuate, and then secondly, decline.
Due to fluctuating and declining hormone levels, menstrual cycles can become irregular, heavier, or lighter.
Menstrual related symptoms (PMS symptoms) may also increase (just when you thought you were done with that!).
Ideally, as practitioners, we would love to work with women who are at the start of this transitionary period so we can help to optimise hormone levels and maintain a regular menstrual cycle for longer.
The perimenopause phase can start as early as the 30’s for some women.
The current tendency is that more and more women are experiencing an earlier menopause. (6)
Women either transition through the menopause naturally, or may reach menopause earlier due to medications such as chemotherapy (‘chemical menopause’) or surgery (‘surgical menopause’).
There are also around 55,000 hysterectomies each year in the UK (6), which would lead to an early menopause.
Causes of menopause include:
Women who transition through the menopause at an earlier age are at a greater risk of developing cardiovascular disease, neurologic diseases, and osteoporosis (7).
Signs and symptoms of menopause
Menopause often takes women by surprise.
In fact, a study demonstrated that on average it can take 13 months for women to link their symptoms to perimenopause.
In the same study, 90% of women failed to link their symptoms to fluctuating hormone levels, instead linking their symptoms to stress, depression or anxiety (8).
Research also suggests that only 3 in 10 women feel well-informed about menopausal symptoms (9).
Frustratingly, it can also take multiple visits to the doctors before symptoms are correctly attributed to the menopause.
Declining hormone levels affect every cell, organ and system in the body and can accelerate ageing.
This can explain why signs and symptoms can be so varied.
The menopausal transition affects each woman uniquely, but the most common signs and symptoms include:
Oestrogen and the menopause
Understanding your hormones is key to the Functional Medicine approach to menopause.
We usually think of the sex hormones being important for fertility and libido, but these hormones are vital for many other functions.
Oestrogen alone has over 400 important functions in the body!
For instance, there are an abundance of oestrogen receptors in different regions of the brain.
There are oestrogen receptors in the thermoregulatory region of the brain (which controls body temperature), in regions critical to learning and memory, and to regulation of sleep and circadian rhythms.
During the early part of perimenopausal phase, while progesterone starts to decline, oestrogen begins to fluctuate, and levels can actually be higher than they were in pre-menopause.
There is a rollercoaster of oestrogen levels, where it can be 30% higher on one day, compared to the next (which is why standard hormone testing in menopause can be difficult).
Some of the perimenopausal symptoms you may experience can be attributed to this yo-yoing of oestrogen levels.
Higher oestrogen (relative to progesterone) and fluctuating oestrogen levels can trigger night sweats and increase appetite.
Fluctuating levels of oestrogen can also contribute to hot flashes, changes in the menstrual blood flow and irregular cycles.
After fluctuating for a period of time, ovarian produced oestrogen levels then begin to decline.
In late stage perimenopause, where oestrogen is low, the body begins to use energy differently.
The function of fat (adipose) cells changes, it becomes easier to gain weight, and there are changes in bone health and cardiovascular health (11).
In fact, women are five times more likely to have a heart attack after the menopause (12), largely due to reduced oestrogen levels.
Symptoms of low oestrogen include:
Progesterone and the perimenopause
The interplay between your levels of oestrogen and levels of progesterone is really important.
Progesterone counterbalances the actions of oestrogen and plays many roles in your body.
Progesterone levels gradually begin to decline in ovulatory menstrual cycles, then once ovulation ceases, progesterone levels become significantly lower.
Low progesterone (relative to oestrogen levels) can contribute to irregular, or heavy periods.
Progesterone (like oestrogen) is so important for brain function.
Progesterone receptors in the brain help to support mood and sleep.
Women frequently report that they can get off to sleep well, but then awake suddenly in the night and find it difficult to get back off to sleep.
Of course, if you’re also experiencing night sweats, then this too causes sleep disruptions.
Progesterone in the brain also acts on GABA receptors (14). GABA is a neurotransmitter that supports mood and sense of well-being.
Therefore, when progesterone is declining, the GABA pathway suffers.
Low progesterone reduces the ability to cope with stress, increases anxiety, insomnia and migraines.
One sex hormone that remains relatively unchanged during menopause, is testosterone.
Even though levels of testosterone stay pretty much the same, this creates a state of relative androgen excess (because as oestrogen and progesterone levels fall, testosterone is then comparatively higher – see graph above).
Androgen excess can increase abdominal fat, insulin resistance and changes in metabolism.
So it’s hopefully clear to see why, during your menopausal years, you can experience a range of signs and symptoms, which are due to fluctuating and declining hormone levels.
The conventional medicine approach to menopause
The conventional medicine approach to menopause is Hormone Replacement Therapy (HRT) to replace low hormone levels.
This is not suitable for women with a history of hormone related cancers, blood clots, or uncontrolled high blood pressure.
Blood pressure medication, or epilepsy medication can be used to help reduce hot flashes and night sweats.
Antidepressants are often prescribed to help with mood symptoms.
The Functional Medicine approach to menopause
The negative symptoms of menopause, and the risks associated with the menopause, are not inevitable.
Women can, and do, experience this transitionary period with positivity and with very few, or no, symptoms.
And we’d love to help you experience this too.
Below are some of the factors to consider in a Functional Medicine approach to menopause and aiding a smooth transition:
Stress, such as a traumatic event, loss of a parent, or breakdown of a marriage, can be a trigger for an earlier menopause.
And what most women don’t know, is that once the ovaries stop producing oestrogen, it’s all down to the adrenal glands to continue making a relatively lower, but still significant, amount of oestrogen (15).
An imbalance in stress hormones, can make matters worse:
Can all further add to stress hormone imbalances, which can make your menopausal symptoms worse.
As the adrenal glands step in to produce some oestrogen when ovarian oestrogen levels decline, adrenal function testing is important for all women to consider.
Better still, optimising adrenal health prior to the perimenopausal phase could prove to be hugely beneficial.
In our experience, we’d go so far as to say that stress hormone health in the years prior to, and during, your menopause, can be a significant predictor of how positive or negative your experience of menopause will be.
Endocrine disruptors are chemicals that we are exposed to in our environment, or through foods, that mimic the action of our hormones, or that disrupt how our hormones communicate with our cells.
Exposure to endocrine disrupters can exacerbate fluctuating hormone levels during the perimenopausal years.
Examples of endocrine disrupters are:
The role of nutrition in menopause is important, both for the immediate symptoms and for the long term health risks.
A lack of vital vitamins and minerals, and appropriate levels of protein, carbohydrates and healthy fats can affect hormone levels (and how hormones are metabolised and eliminated from the body).
Antioxidants are beneficial in supporting the menopause transition. They do this by supporting cellular energy metabolism and insulin sensitivity.
Anti-inflammatory foods and nutrients, such as omega 3 fatty acids, may be beneficial in supporting the cardiovascular system (17) and reducing blood pressure (18).
Optimising vitamin D, vitamin K, boron, calcium and magnesium are important to maintaining bone mineral density (19).
Adequate protein is important for:
Phytoestrogen rich foods are foods that contain an oestrogen-like substance that can also provide some support as ovarian hormone levels decline.
Many herbs have also been used to support the menopause such as black cohosh, shatavari and dong quai.
Declining hormone levels cause metabolic changes, including altered insulin and blood glucose levels.
This means that the body is less efficient at using calories for fuel, and it becomes easier to develop insulin resistance.
Therefore, an optimal body weight and body fat percentage, prior to entering the menopause, can be protective against developing diabetes and cardiovascular disease post-menopause.
Body weight and body fat percentage can be improved even when in the peri-menopausal period with an appropriately tailored nutrition and lifestyle protocol.
Blood sugar management
Effective blood sugar management can help support weight management, insulin sensitivity, energy and mood.
Considering meal timing, protein and fat content of meals, phytonutrients from plant-based foods, fibre and exercise can all help to improve weight, mood and energy.
A balanced microbiome can be protective against the development of diseases that are common in women after the menopause.
Prebiotics and probiotics can support healthy oestrogen metabolism and reduce inflammation.
Sleep quantity and quality can be supported through nutritional and lifestyle strategies.
Getting into a healthy sleep routine, as well as increasing magnesium, avoiding artificial lights, and stress reduction techniques may help to get a better nights sleep.
The GABA pathway (GABA is a neurotransmitter that supports mood and sense of well-being) can be supported with nutrients such as theanine, magnesium and vitamin B6.
Supporting the stress hormone axis, and addressing higher cortisol (stress hormone) levels in the evening, can also help to achieve a deeper, more restorative sleep.
It could also be worth experimenting with macronutrient ratios (carbohydrates, protein, fats) to find the right balance for you.
Higher carbohydrates in the evening can help some people get a better nights sleep AND help lose weight (if you’re otherwise on a low carbohydrate diet, yes really, it’s true!).
The DUTCH hormone testing panel is key to the Functional Medicine approach to menopause, and is one of our go to tests to help understand our clients hormone levels.
The numerous markers in a DUTCH test can give us details on the levels of the hormones to help figure where exactly you are in the menopausal process.
We can also assess the ratios of hormones to each other, how are they moving through the liver, and information around dopamine, serotonin, and melatonin levels.
The DUTCH testing also provides the most advanced assessment of adrenal gland function (or more accurately the hypothalamus-pituitary-adrenal (HPA) axis).
You can find out more about the DUTCH tests over at the Precision Analytical labs website here.
Other hormone tests that we may consider include the HUMAP (Hormone & Urinary Metabolites Assessment Profile).
Understanding your thyroid health is essential for all women.
Subclinical hypothyroidism (low thyroid) is so common in women, and something that can develop as we get older.
Optimal thyroid hormones support metabolism, temperature regulation, energy, weight, skin, and mood – the same symptoms that are also present due to declining ovarian hormones.
Menopause can be a difficult, traumatic experience for many women, as well as for those around them.
It doesn’t have to be that way though, and there’s a lot that can be done to help you have a positive experience of menopause.
The more pro-active you are in recognising your menopausal symptoms and getting early help, the better your menopause is going to be.
Having worked with so many women who are going through their menopause already, we’d love to help you too.
To your optimised, healthy future,
Dee & the Coho Health team
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