Menopause marks the end of a females reproductive lifecycle. It is a normal event and therefore is not considered a disease. Diagnosis is made clinically after a 12 months of amenorrhea. The process is gradual, taking place over the course of 4-7 years.
The characteristic reduction in oestrogen is the cause for a range of symptoms associated with menopause, and increases several risk factors for other conditions like cardiovascular disease, osteoporosis, changes in immune stability, low libido, breast cancer, and metabolic conditions like diabetes.
Menopause begins with perimenopause, which can last several years as ovarian function gradually decreases. It is diagnosed following a 12 month absence of menstruation. The average age of menopause is age 51 [2 ,11].
Beginning around age 38, the rate of follicle disappearance begins to accelerate. Over time, female gonad levels diminish to the point where it is unable to provide enough mature follicles to sustain menstrual cyclicity.
FSH and LH are increased in menopause, while progesterone and estrogen are decreased. Surges in LH are thought to be the main cause in the pathophysiology of hot flashes, and subsequent diaphoresis and flushing of the face and neck [7, 8, 11].
With a drop in oestrogen, the protective action of the hormone is diminished, which can lead to confounding conditions like metabolic syndrome , hypotension, and osteoporosis. The loss of oestrogen also accounts for many of the other symptoms including fatigue, muscle and joint pain, vaginal dryness, lowered libido, maintenance insomnia, and headaches. In some instances these side effects can last several years in post menopausal women.
Risk Factors With Menopause:
Menopause puts women at a greater risk of developing cardiovascular disease, metabolic syndrome and diabetes, breast cancer (especially if in conjunction with elevated testosterone) , and osteoporosis.
Muscle and joint pain
Urinary Tract Irritation
+ Hot Flashes
Hopt flashes (AKA hot flushes) are the most characteristic trait of menopause and estrogen deficiency in general (75% of women will experience at least one). These vasomotor symptoms can involve night sweats and facial skin flushing as well.
They are defined as a recurrent transient sensation of heat, diaphoresis, chills, and may be accompanied by heart palpitations or anxiety.
It is thought to be the result of a thermoregulatory center (in the hypothalamus) dysregulation due to estrogen withdrawal. The result is temporary peripheral vasodilatation and increase in blood flow.
+ Urogenital Changes
Thinning of the cells lining the vulva, urethra, and vagina can lead to reduced epithelial secretions and dryness and pH changes which may then lead to symptoms of vaginosis. Recurrent urinary tract infections are far more common.
Additional changes to the urogenital system after a drop in estrogen levels includes dysuria, urinary incontinence, and increased urinary frequency.
- Cardiovascular disease
- Metabolic syndrome
Normal Hormone Ranges
|Hormone||Normal Range||Typical Findings In Menopause|
|Beta Human Chorionic Gonadotrophin (HCG)||xxx||xxx|
|Follicle Stimulating Hormone (FSH)||xxx||High|
|Luteinizing Hormone (LH)||xxx||High|
|Anti-Mullerian Hormone||xxx||Very Low|
- Pelvic imaging (US, MRI, CT)
- FBE, ferritin, coagulation
- Genital cultures, DNA & viral probes
- Chlamydia trachomatis
- Neisseria gonorrhoeae
- Human papilloma virus (HPV)
- Herpes simplex virus (HSV)
- Histology: (Pap) smear
- Pelvic Endoscopy
- Breast imaging
- Mammography, ultrasound, MRI
1. Assist The Adaptation To Lower Oestrogen Levels.
Reduce the effects of oestrogen withdrawal.
- Phytoestrogens (Glycine max, Humulus lupulus)
- Saponin containing herbs (Tribulus terestris, Chamaelirium luteum, Asparagus racemosa, Dioscorea spp., Alchemilla vulgaris)
2. Support The Adrenal Glands
Support increased burden to produce estrogens as a result of a loss in ovarian support.
- Adrenal tonics (Rehmannia glutinosa)
- Adaptogens (Withania somnifera, Panax ginseng, Eleutherococcus senticosus)
3. Support The Nervous System And Treat Any Insomnia Or Anxiety
- Nervine relaxants (Avena sativa)
- Anxiolytics (Passiflora incarnata, Hypericum perforatum)
4. Treat Hot Flushes Symptomatically
- Salvia, Crataegus oxycanthus, Leonurus cardiaca, Vitex agnus castus
5. Treat Infection (If Applicable)
- Antibacterials(Tabebuia impetiginosa)
- Antivirals(Sambucus nigra, Melissa officinale)
Amenorrhea and FSH Levels
|FSH Low||Neuroendocrine stress||Female athelte triad, Prolactinoma|
|FSH Normal||Comorbid endocrine disease||PCOS, Hypothyroidism|
|FSH High||Premature ovarian insufficiency/failure||Menopause|
The most important thing to rule out in any female reproductive system complaint is pregnancy. Beta HCG is the best test for ruling this out.
Herbs For Menopause:
- black cohosh
- red clover
- helonias root
- ladies mantle (achemilla vulgaris)
- panax ginseng
- Angelica sinensis
- leonurus cardiaca
Drugs Used For Menopause:
- Bioidentical hormones
- Tibolone – Livial®
The Sunlight Experiment
Updated: October 2017
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