Jennifer Griffin, M.D.
Sutter Medical Group
Integrative Medicine
Empowering You through Menopause:
A Holistic Approach to Hormone Balance
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• How hormone levels change over time
• Symptoms of perimenopause and menopause
• Hormone testing
• Nutrition and lifestyle interventions
• Treatment options
• Hormone replacement therapy
Objectives
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Changes in Estrogen
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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:
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Officially PMP after 12 consecutive
months without a period
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Estrogen & Progesterone Over Time
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• 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
Daily Stress
Adrenal
Thyroid
Sex
Hormones
• Cortisol
• DHEA
• TSH, T4,
T3, RT3
• Estrogen
• Progesterone
• Testosterone
Stress and the
Hormone Axis
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Endocrine Disruptors
Xenoestrogens (estrogen mimics)
add to the problem
Reduce exposure to chemicals, toxins
and exogenous hormones.
• BPA
• Phthalates
• Parabens
• Pesticides
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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
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• 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
• 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
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Symptoms of Menopause
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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.
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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
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Hormone Testing
Menopause
• Declining estradiol, but still
fluctuating
• Generally low progesterone
Postmenopause
(12 months since last period)
• High FSH, low estradiol,
low progesterone
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A Woman’s Life in Hormones
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It matters for women too!
• Fatigue/ low motivation
• Memory loss
• Decreased sex drive
• Muscle and bone loss
• Joint pain
• Depression
• Anxiety
What About
Testosterone?
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• Ovaries continue to make
testosterone
• Gradual decline over time
• Variable levels in women
• Affected by exercise,
medications, chronic stress
What About Testosterone?
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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?
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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?
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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
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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
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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.
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Phytoestrogens in Foods
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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