Visit 1: Empowering You through Menopause

Transcript

1. Jennifer Griffin, M.D. Sutter Medical Group Integrative Medicine Empowering You through Menopause: A Holistic Approach to Hormone Balance
2. • How hormone levels change over time • Symptoms of perimenopause and menopause • Hormone testing • Nutrition and lifestyle interventions • Treatment options • Hormone replacement therapy Objectives
3. Changes in Estrogen
4. Phases of Menopause • Perimenopause: ◦ As early as mid 30’s / early 40’s when still having periods ◦ Can last 5-10 years ◦ Irregular periods, anovulation • Menopause: ◦ Periods stop ◦ Avg. age 51 years • Postmenopause: ◦ Officially PMP after 12 consecutive months without a period
5. Estrogen & Progesterone Over Time
6. • Estrogen dominance is a common occurrence in perimenopause o Due to excess estrogen OR low progesterone • Progesterone naturally drops sooner than estrogen o Why? skipped periods/ lack of ovulation Perimenopause and Estrogen Dominance
7. • Exacerbating factors: ◦ Excess weight / obesity ◦ Poor diet (sugar, processed food, lack of fiber) ◦ Excess alcohol ◦ Genetics/ poor estrogen clearance ◦ Endocrine disrupting chemicals ◦ Excess stress (cortisol steal) Estrogen Dominance
8. Cortisol Steal
9. Daily Stress Adrenal Thyroid Sex Hormones • Cortisol • DHEA • TSH, T4, T3, RT3 • Estrogen • Progesterone • Testosterone Stress and the Hormone Axis
10. Endocrine Disruptors Xenoestrogens (estrogen mimics) add to the problem Reduce exposure to chemicals, toxins and exogenous hormones. • BPA • Phthalates • Parabens • Pesticides
11. Endocrine Disruptors • Hormones in meat and dairy • Others (see EWG.org for info re: endocrine-disrupting chemicals) https://www.ewg.org/search?fullsearch =endocrine+disrupting+chemicals
12. • Clean up your beauty routine! • Swap out harmful household products (tupperware, household cleaners, air fresheners, candles) for low hazard alternatives • See EWG website to find hazard scores for your products https://www.ewg.org/skindeep/ • Healthy Living App Endocrine Disruptors
13. 1. Menorrhagia (heavy flow) 2. PMS/ Menstrual migraine 3. Anxiety/ Depression 4. Uterine fibroids 5. Endometriosis 6. Breast cysts 7. Infertility 8. Insomnia Conditions Associated with Estrogen Dominance
14. • Irregular periods • Change in flow (heavier or lighter) • Hot flashes / night sweats • Poor sleep • Fatigue • Low tolerance for stress • Mood swings/ irritability • Low libido • Weight gain Perimenopausal Symptoms
15. Symptoms of Menopause
16. Hormone Testing FSH – Follicle Stimulating Hormone • Made by pituitary gland (brain) • Signals ovaries to make estrogen • Down when ovaries are making estrogen • Up and down in perimenopause • Remains elevated once periods have stopped.
17. Perimenopause • Estradiol and FSH fluctuate • Progesterone production drops, often the culprit of perimenopausal symptoms • Testing can be useful to confirm estrogen dominance, but tricky… Hormone Testing
18. Hormone Testing Menopause • Declining estradiol, but still fluctuating • Generally low progesterone Postmenopause (12 months since last period) • High FSH, low estradiol, low progesterone
19. A Woman’s Life in Hormones
20. It matters for women too! • Fatigue/ low motivation • Memory loss • Decreased sex drive • Muscle and bone loss • Joint pain • Depression • Anxiety What About Testosterone?
21. • Ovaries continue to make testosterone • Gradual decline over time • Variable levels in women • Affected by exercise, medications, chronic stress What About Testosterone?
22. Nutrition / Supplements • Anti-inflammatory diet: Mitochondrial food plan (detailed at visit 2) • Phytoestrogens, herbs and supplements Exercise • 150 mins / week at least moderate intensity. Include interval training (HIIT) to optimize wt loss What Can We Do?
23. Sleep • Consistent sleep / wake time supports circadian rhythms. Aim for 8 hrs / night Manage stress • Cortisol surges, caffeine and alcohol can worsen hot flashes Intermittent fasting • Weight control, fatigue, blood sugar, sleep What Can We Do?
24. Phytoestrogens Estrogen like compounds in plants Soy Isoflavones Tofu, miso, tempeh, edamame, soy milk, soy nuts Lignans Flax seed, fruits, whole grains Supplements Rhubarb, Red clover, Hops, S-equol Herbs and Supplements
25. Black Cohosh Hot flashes, irritability/ mood Chaste Tree (aka vitex) Hot flashes, mood, PMS Maca Hot flashes, fatigue, mood, libido Shatavari, Tribulus Libido Herbs and Supplements
26. Herbs and Supplements Estroven Complete (rhubarb) Femmenessence (maca) Remifemin (black cohosh) Equelle – S Equol Intestinal bacteria convert daidzein (a soy isoflavone) into S-equol. Approx 1/3 of women can convert.
27. Phytoestrogens in Foods
28. Sleep Melatonin, magnesium, lemon balm, valerian, Ltheanine Anxiety / Irritability Ltheanine, GABA, magnesium, ashwagandha Depression 5HTP ( limit dose if on SSRI), SamE, rhodiola St John’s Wort (caution: interacts with some medications) Herbs and Supplements
29. Stress Management • Yoga / Meditation / Breathwork • Heart Math ( biofeedback) • Massage Therapy • Acupuncture • Nature • Fun!
30. Mindfulness: Mind-Body Medicine Guided meditation: • Apps: Calm, Headspace, Insight Timer • Set a goal: 5 to 10 mins/day Mindful breathing exercises: • Apps: iBreathe, Breathe • 4-7-8 exercise • Belly breathing
31. Mindfulness-Based Stress Reduction: • 8 week course created by Jon Kabat Zinn • https://osher.ucsf.edu/public- classes/MBSR • https://www.ummhealth.org/umass- memorial-medical-center/services- treatments/center-for- mindfulness/mindfulness-classes • https://jonkabat-zinn.com/ Mindfulness: Mind-Body Medicine
32. Thank You! Questions?