Menopause Flashcards
Menopause
The life stage where menstruation and reproductive potential ceases.
Menopause stages
- Premature menopause (<40 yrs.): Permanent (bilateral oophorectomy) or due to ovarian insufficiency (genetics).
- Early menopause (40‒45 yrs.): Cessation of ovarian function without identifiable underlying secondary cause. Affects 5‒12%.
- Perimenopause (around 45‒50 yrs.): Begins from the onset of irregular menstrual cycles and ends 1 year after the final period.
- Menopause (50‒55 yrs.): After 12 months of amenorrhoea.
- Post menopause (55 onwards): Periods cease and generally the worst of the hormonal symptoms have subsided.
Perimenopause
The transition phase of declining reproductive
hormones where ovarian follicular activity begins to fail.
* Hormonal changes: FSH / LH levels rise due to reduced negative feedback. FSH levels can vary markedly. O:P ratio fluctuates a lot during perimenopause.
Menopause
Low oestrogen, persistently high FSH
(> 30 iu / L checked 4‒6 weeks apart) and LH levels.
Note: FSH is not accurate in perimenopause.
Post menopause
~65% produce sufficient testosterone in their adrenal glands to sustain libido. Assessing adrenal health pre-menopause is a valuable tool to assist a smoother transition.
Factors affecting menopause transition
- Obesity
- Smoking
- Chronic stress (HPA axis)
- Long term lead exposure
- Gut microbiome changes
- Family history
- Hypertension
Menopause: Signs and symptoms
- Vasomotor Symptoms (VMS): Hot flushes / flashes
- Weight gain and obesity
- Sleep disturbance
- Genitourinary symptoms dry / sore vagina,
dysuria, dyspareunia. Urogenital atrophy. - Mood disturbances
- Other: hair loss, joint and muscle pains, headaches, itching skin, burning tongue, daytime fatigue, low libido. Loss of confidence and reduced self esteem. Memory / concentration issues.
VMS
- Vasomotor Symptoms (VMS): Hot flushes / flashes characterised by sudden intense sensation of warmth (affecting the face, neck, chest); often followed by a chill.
- 30-70% of women experience VMS during perimenopause.
- Negatively affected by obesity, smoking, alcohol, spicy foods, caffeine and stress.
- VMS contribute to sleep disturbances.
- Women with a plant based diet appear to experience less menopausal VMS.
- Proposed mechanism: Oestrogen is a neuromodulator, changes in levels can impact areas involved in temperature homeostasis.
Natural approach to menopause:
CNM Naturopathic Diet
* Increase antioxidants and fibre from fruits and vegetables.
* Include a phytoestrogen source daily.
* Choose more plant than animal proteins
* Regular pre and probiotic foods.
* Drink at least 1.5 litres of water a day.
* Maintain a low GL, omega 3 rich diet.
* Avoid foods / beverages which can aggravate hot
flushes, e.g., coffee, very spicy foods and alcohol.
* Increase phytoestrogen foods and herbs, e.g., flaxseeds, sage, fermented soy (non GM). Red clover.
* Sage home remedy 6 sage leaves soaked in lemon juice overnight in the fridge. Strain and drink lemon juice in water.
* Reduce weight and focus on balancing blood glucose
levels hypoglycaemia increases hot flushes.
* Acupuncture has been shown to reduce VMS.
* EPO
* Avoid smoking, alcohol and caffeine.
* Herbal medicines
*↓ fracture risk (support bone density) calcium, vitamin C, D, K2, magnesium , black cohosh
Weight bearing exercise (promotes osteoblasts).
* Manage stress / anxiety
* Improve sleep
* GU health use organic natural lubricants (close to vaginal secretions pH); oral or local probiotics (
lactobacillus based).
* Optimise intestinal microbiome
Herbal medicines for menopause
- Black cohosh oestrogen modulating (isoflavone content) and energetically cooling. Reduces hot flushes and supports BMD.
- Shatavari reproductive tonic ( testosterone like effects) and adaptogen. Relieves vaginal symptoms incl. vaginal dryness.
- Valerian root, passionflower and chamomile nervines.
- St. John’s wort extract reduces hot flashes,
improves sleep, mood and relieves anxiety . - Liquorice root mildly oestrogenic (isoflavones).
- Maca improves libido, sleep, mood and hot
flushes. Appears to interfere with androgen receptors.
