The Harvest Functional Medicine Approach to Menopause Management
Things that real women have told me in the past year:
"My kids told me that I am angry all the time."
"I can't sleep."
"I wake up in a puddle."
"I have no sex drive, and it is becoming more and more painful."
"I can't do the things that I used to be able to do."
"I am gaining weight, and haven't changed anything!"
"I feel tired all the time."
"I am getting depressed."
"My anxiety is out of control."
"I'm losing my hair."
The onset of menopause has, unfortunately, become a predictor of misery for women. Menopause is widely discussed as a dreaded time of life that many women have come to assume must be uncomfortable. While it is common for women to experience symptoms that are quite unpleasant, it does not have to be the norm. At Harvest, we believe that you can thrive in this season of your life. We value holistic care in the management of menopause symptoms, and take careful steps to support your body through the inevitable changes that must occur in every woman.
Are you in menopause?
Here are the definitions of common terms utilized to describe menopause:
Perimenopause: begins around 40 years old (can range from mid-30's to early 50's), and is the the initial fluctuation in hormone production.
Menopause: Menopause is defined as "going 12 months without a period." The average age for menopause in the US is 51 years old (1).
Common symptoms of perimenopause and menopause:
Irregular periods
Vaginal dryness
Hot flashes
Chills
Night sweats
Sleep problems
Mood changes
Weight gain and slowed metabolism
Thinning hair and dry skin
Loss of breast fullness
Why Menopause Management Matters
Relationships: It is no surprise that menopause can affect relationships with partners, family, and friends. The data on how impactful this transition can be on important relationships, however, is quite alarming. A 2019 study concluded that there was a positive association between the severity of menopausal symptoms and relationship distress (2). The most common complaints about menopause are irritability, low sex drive, hot flashes, and weight gain- all of which could obviously be impactful to a woman's daily interactions with people in her life.
Mental health: Menopause can cause new onset, or exacerbation of anxiety, depression, and mood swings (3). It is no secret that mental health can be hugely impactful to quality of life, and addressing the root cause of these symptoms is key to sustainable improvement.
Physical health: Changes that occur in menopause can affect every system in the body:
Neurological health: cognitive functioning can decline leading women to become more forgetful and have disruption in focus. Temperature dysregulation and sleep disruptions are common as well.
Skin: skin becomes less elastic, facial hair can increase, discoloration may occur, and some women even have onset of acne.
Bones: dropping hormone levels can cause rapid loss of bone denisty, which increases the risk for osteoporosis.
Muscles: many woman experience muscular atrophy and weakness during menopause.
Cardiovascular: with menopause, the risk of cardiovascular disease (elevated blood pressure, clotting, heart disease, stroke) significantly increases.
Metabolic: weight management becomes very challenging for many women, as the risk for insulin resistance significantly increases at this time of life.
Gastrointestinal: many woman will experience bloating, abdominal pain, diarrhea, or constipation. Bile production also can decrease during this time of life, making food digestion more difficult and therefore causing GI inflammation and nutrient deficiency.
Urinary: because menopause changes cause the skin to lose elasticity, and can cause atrophy of tissues in the gential region, urinary incontinence is very common in menopausal and postmenopausal years. Addressing these issues with topical estrogen, kegal exercises, and pelvic floor physical therapy can help decrease risk for urinary incontinence or urinary tract infections.
Sexual function: vaginal dryness, decreased libido, can all occur with the drop in hormone levels associated with menopause, making sex painful and unpleasant for many women. At times the vaginal dryness and atrophy can be so painful that it is uncomfortable all throughout the day, even with other typical daily activites.
I know, at this point you are thinking, "well, no wonder everyone is miserable, of course they are!" But, keep reading, I promise there is hope.
A note on premature onset of menopause:
It is worth mentioning here that early onset of menopause (menopause onset <age 40yo) can have a number of causes, including (but are not limited to): hysterectomy (partial or full), physical or mental stress, nutrient deficiency, gut issues, radiation, and insulin resistance. Many of these causes are reversible! It is important to seek care (preferably with a functional medicine provider who will address the 'whole picture') for premature onset of menopause because it puts women at higher risk for coronary artery disease, stroke, Parkinson's, dementia, Alzheimer's, osteoporosis, cancer, and sexual dysfunction.
Alright, now we get to the good stuff- the reason you're probably still here.
"WHAT DO I DO ABOUT ALL OF THESE AWFUL SYMPTOMS?"
I'm so glad you asked.
Conventional vs. Functional Approach to Menopause
Conventional Management of Menopause
The American College of Obestetricians and Gyenocologists (ACOG) recommends synthetic estrogen hormone replacement for sympotms of low estrogen when indicated. ACOG also considers prescription medications for menopause symptoms relief, including: SSRI's (antidepressants), gabapentin (an anticonvulsant or anti-seizure medication), and clonidine (a blood pressure medication), for the reduction of hot flashes and insomnia associated with menopause. They also recommend selective estrogen receptor modulators (SERMs), which are drugs that act on tissues that respond to estrogen, for the relief of hot flashes and pain during intercourse caused by vaginal dryness. ACOG does recommend a diet high in vitamin D and calcium to maintain bone density, and encourages regular exercise as well (5).
The Functional Medicine Approach to Menopause
The American College of Obstetricians and Gynecologists (ACOG) recommends synthetic estrogen hormone replacement for symptoms of low estrogen when indicated. ACOG also considers prescription medications for menopause symptoms relief, including: SSRI's (antidepressants), gabapentin (an anticonvulsant or anti-seizure medication), and clonidine (a blood pressure medication), for the reduction of hot flashes and insomnia associated with menopause. They also recommend selective estrogen receptor modulators (SERMs), which are drugs that act on tissues that respond to estrogen, for the relief of hot flashes and pain during intercourse caused by vaginal dryness. ACOG does recommend a diet high in vitamin D and calcium to maintain bone density, and encourages regular exercise as well (5).
The functional medicine protocol then is built to make an individualized plan that meets the needs of your body, and fits into your personal life.
Nutrition
Targeting nutrition is essential to management of menopausal symptoms. Specific foods can be incorporated to promote production of the hormones that you may be deficient in. For example, sweet potatoes, nuts, dark chocolate, legumes, and avocado may promote progesterone production, whereas minimally processed soy, flax seeds, berries, and garlic may promote estrogen production. Some foods can also be incorporated into your diet to help metabolize hormones that seem to be building up. For example, cruciferous vegetables are important for the metabolism of estrogen, so if you are Estrogen Dominant, these veggies may be part of your nutrition plan.
Exercise
Movement is obviously important to overall health, there is no argument against this fact. As you approach the menopausal years, certain types of movement become even more important to incorporate into your weekly rhythms. Resistance training is key to maintaining bone density and muscle tone. Aerobic training is also supportive to your cardiovascular system. Both types of exercise promote wellness, and when balancing hormones, it is recommended to work with your provider to make a plan that works with your individual body needs.
Address Insulin Resistance (weight management)
The drop in estrogen has been shown to decrease cellular sensitivity to insulin, which essentially means that your body has a more difficult time moving glucose from the blood into the cell, raising your average blood sugar (8). This is known as insulin resistance (IR). IR can be improved with diet and lifestyle changes, which can be effective for managing that abdominal weight gain that is common in menopause. Balancing hormones can decrease your risk of developing cardiovascular disease and diabetes because of this very reason. Working with a medical professional is important in monitoring your blood sugar.
Decreasing Systemic Inflammation
Unnecessary and elevated inflammation causes disruption in hormone production, and can exacerbate the symptoms of menopause (9). Not to mention that risk of cardiovascular disease, autoimmune disease, and mental health issues are directly correlated with inflammation levels. Working with a functional medicine provider to get to the root cause of your systemic inflammation can be key to longevity and quality of life.
Addressing Hormonal Balance
With functional medicine, we address hormone imbalances using nutrition, exercise, supplementation, herbal remedies (11), and hormone replacement therapy (10) as indicated. Estrogen, progesterone, testosterone, DHEA, cortisol, FSH/LH, and thyroid hormone are all assessed and balanced with a functional approach to get you feeling your best.
Functional medicine also takes your genetics into consideration. For example, methylation is essential to the metabolism of hormones (and may other compounds in your body)- if you have a particular genotype in relation to methylation, you may be at higher risk for certain disease processes such as endometriosis, PCOS, breast or ovarian cancer, and infertility. If you are found to have these genetic mutations that show you may have a more difficult time with methylation, supplementation and nutritional support may be recommended by your provider.
Improving Gut Health
In functional medicine, we say time and time again that everything starts with a healthy gut. Gut health is essential for hormone balance because it impacts your nutrient bioavailability to synthesize hormones, supports the process of producing hormones, and modulates transportation and metabolism of hormones. Every hormone balancing protocol should include an assessment and restoration of the gut microbiome, gut lining integrity, and digestive functioning.
There are many steps that you can take on your own to manage your menopause symptoms- check out our free guide here with a checklist of lifestyle changes you can make to start your journey towards cultivating health in menopause.
If you find that these steps are not enough to find relief, reach out to a functional medicine provider to help you create a protocol that will help you THRIVE in this season of life. Menopause is inevitable, but it does not have to be miserable!
1 . “Menopause - Symptoms and Causes.” Mayo Clinic, www. .org/diseases-conditions/menopause/symptoms-causes/syc-20353397#:~:text=It.
2. Association between menopausal symptoms and relationship distress. Kling, Juliana M. et al. Maturitas, Volume 130, 1 - 5
3. “Menopause and Mental Health.” Harvard Health, 1 Mar. 2020, www.health.harvard.edu/womens-health/menopause-and-mental-health#:~:text=Shifts%20in%20the%20levels%20of.
4. Faubion, S. S., et al. “Long-Term Health Consequences of Premature or Early Menopause and Considerations for Management.” Climacteric, vol. 18, no. 4, 7 Apr. 2015, pp. 483–491, www.ncbi.nlm.nih.gov/pmc/articles/PMC4581591/, https://doi.org/10.3109/13697137.2015.1020484.
5. “The Menopause Years.” www.acog.org, www.acog.org/womens-health/faqs/the-menopause-years.
6. Mei, Zhaojun, et al. “The Role of Vitamin D in Menopausal Women’s Health.” Frontiers in Physiology, vol. 14, 12 June 2023, www.ncbi.nlm.nih.gov/pmc/articles/PMC10291614/, https://doi.org/10.3389/fphys.2023.1211896.
7. Carr, Molly C. “The Emergence of the Metabolic Syndrome with Menopause.” The Journal of Clinical Endocrinology & Metabolism, vol. 88, no. 6, June 2003, pp. 2404–2411, https://doi.org/10.1210/jc.2003-030242.
8. Yan, Hui, et al. “Estrogen Improves Insulin Sensitivity and Suppresses Gluconeogenesis via the Transcription Factor Foxo1.” Diabetes, vol. 68, no. 2, 28 Nov. 2018, pp. 291–304, https://doi.org/10.2337/db18-0638.
9. McCarthy, Micheline, and Ami P. Raval. “The Peri-Menopause in a Woman’s Life: A Systemic Inflammatory Phase That Enables Later Neurodegenerative Disease.” Journal of Neuroinflammation, vol. 17, no. 1, 23 Oct. 2020, www.ncbi.nlm.nih.gov/pmc/articles/PMC7585188/pdf/12974_2020_Article_1998.pdf, https://doi.org/10.1186/s12974-020-01998-9.
10. Mikkola, Tomi S., et al. “Estradiol-Based Postmenopausal Hormone Therapy and Risk of Cardiovascular and All-Cause Mortality.” Menopause (New York, N.Y.), vol. 22, no. 9, 1 Sept. 2015, pp. 976–983, pubmed.ncbi.nlm.nih.gov/25803671/, https://doi.org/10.1097/GME.0000000000000450. Accessed 13 Nov. 2020.
11. Kargozar, Rahele, et al. “A Review of Effective Herbal Medicines in Controlling Menopausal Symptoms.” Electronic Physician, vol. 9, no. 11, 25 Nov. 2017, pp. 5826–5833, https://doi.org/10.19082/5826. Accessed 25 Nov. 2019.
12. Ennour-Idrissi, Kaoutar, et al. “DNA Methylation and Breast Cancer Risk: An Epigenome-Wide Study of Normal Breast Tissue and Blood.” Cancers, vol. 12, no. 11, 23 Oct. 2020, p. 3088, https://doi.org/10.3390/cancers12113088. Accessed 23 Sept. 2021.
The content on this website is for general information and educational purposes only, and is not meant to serve as medical advice to diagnose or treat illness. Please consult with your medical provider before making changes to your diet, lifestyle, medication regimen, or supplements.
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