As women approach menopause, sex hormones naturally start to decline. Menopause, marked by the cessation of menses for 12 consecutive months, has many years leading up to it when women will begin to feel their bodies changing. This "reverse puberty" stage is called Perimenopause and typically lasts for about four years.  

During this transitional phase, it's estimated that 85% of women will have some menopausal symptoms. With that being said, many of these women are not seeking care for their symptoms. Options for symptom relief are geared towards supporting the hormonal imbalance that occurs in this life stage. Integrative and functional medicine, along with conventional care, can play a dynamic role in supporting you through this life-changing time.

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What Are Hormones?

Your endocrine organs make chemical messengers called hormones. These messengers are transmitted throughout the body to communicate and integrate bodily function between organ systems. While female sex hormones will be the focus of this article, science has identified over 50 different hormones. Sex hormones are produced by the ovaries in females. The primary hormones are estrogen, progesterone, and testosterone. These hormones, along with luteinizing hormone and follicle-stimulating hormone, are responsible for the reproductive processes in puberty, during your menstrual cycle, pregnancy, and menopause.

What is Hormone Therapy?

There is some confusion when it comes to the term Hormone Therapy. In the medical world, it is a common term used in cancer treatment. There are specific cancers that rely on hormones in order to grow. Hormone-dependent cancers include some breast cancers and prostate cancer. Hormone therapy, in this case, is the use of drugs like Aromatase inhibitors or selective estrogen receptor modulators (SERMS) to either stop the body's natural hormone production, alter sex hormones, or block the hormone from connecting to hormone-dependent cancer cells. Outside of the cancer field, hormone therapy can sometimes be used as a synonym for Hormone Replacement Therapy (HRT) or Bioidentical Hormone Replacement Therapy (BHRT).

Signs & Symptoms of Hormone Imbalance

Each woman may present differently, but all have hormonal imbalances. Here are some of the common symptoms:

• Heavy Periods
• Irregular menstrual cycles
• Absent menses
• Low libido
• Hot flashes
• Infertility
• Vaginal dryness
• Depression
• Anxiety
• Fatigue
• Sleep troubles
• Irritability
• Anger
• Acne
• Hirsutism
• Unexplained weight loss or gain

Is There a Difference Between Hormone Therapy and Hormone Replacement Therapy

Hormone Therapy and HRT are the same in that they influence hormones in your body but differ in their purposes. Hormone therapy, as explained above, is geared towards stopping hormonal processes, whereas Hormone Replacement Therapy supplies the body with more female sex hormones to replenish a deficiency. The first is primarily used in cancer-directed treatment, while HRT is designed to supply hormones to menopausal women who are no longer making their own.

What Causes Hormonal Imbalance in Women?

There are three main categories that hormone imbalances can be categorized into. First is reproductive complications during-puberty, pregnancy, and menopause. Menopause is of primary concern here, resulting from the ovaries no longer making female sex hormones. Women in menopause will have a drastic decrease in estrogen which affects everything from low libido to stress, mental health decline, vaginal discomfort, and diet.

For women, stress can impact all areas of health, especially the functions involved in hormone health. One study looked at the new onset of stress in women who were incarcerated. It analyzed the menstruation of 446 women, finding 9% had amenorrhea and 33% reported menstrual irregularities. Findings concluded that with the new onset of stress combined with past stressful life situations, these women are a prime example of what chronic stress can have on female hormonal function.

The endocrine system of women has been increasingly impacted by autoimmunity. Hashimoto’s Thyroiditis is an underactive autoimmune thyroid condition that can cause irregular menses and fertility issues. Research suggests that the development of autoimmunity is also affected by endocrine transitions like puberty and menopause. During these changes, sex hormone imbalances can be a risk factor for the development of autoimmunity.

Benefits of Hormone Therapy

Hormone Therapy, better known as Hormone Replacement Therapy, is best utilized in the treatment of ovarian insufficiency. When your body naturally enters perimenopause, your sex hormones will begin to decline. There are numerous benefits to taking HRT, including improved sleep and bone health, reduced vaginal irritation, relief from vasomotor symptoms, and reduced risk of heart disease and dementia.

Functional Medicine Labs to Test for Root Cause of Hormone Imbalance

The following are beneficial functional labs to help assess the root cause of hormonal imbalances:

Female Sex Hormone Test

A comprehensive test for female hormones is the DUTCH Complete. This will assess the three estrogen makers: Estrone (E1), Estradiol (E2), and Estriol (E3), which can give insight as to where you are in your menopausal transition. This test will also examine testosterone, progesterone metabolites, cortisol patterns, and other hormone-related biomarkers. This is a great option if you are looking to utilize HRT as a therapeutic intervention.

Thyroid Panel

Sex hormones can influence thyroid function, especially in estrogen-imbalanced conditions. A Thyroid Panel is useful in investigating thyroid health while also screening for potential symptomatic involvement. Estrogen can also impact thyroid levels, so it is important to assess thyroid hormones before implementing HRT.

Stress Panel

If you are enduring excessive stress and are symptomatic, the Comprehensive Adrenal Function Profile may be an appropriate test. This is a salivary test that measures cortisol at multiple intervals throughout a 24-hour period. It also looks at DHEA and IgA, which are biomarkers that can indicate high stress and immune system dysfunction.

Autoimmunity Markers

Access Medical Laboratories has an AutoImmune Analyzer test that looks at ANA, a marker for autoimmunity, as well as specific disease process autoantibodies. This test is great if you have suspected autoimmunity but no previous diagnosis.

Conventional Treatment for Hormone Imbalance

Regarding sex hormone deficiencies, Hormone Replacement Therapy (HRT) is a valuable option. Due to the sudden decline of estrogen from the ovaries, you may get an overwhelming amount of symptoms described above. Adding exogenous hormones can be systemic or local in the form of a pill or vaginal cream. Both estrogen and progesterone can be utilized as HRT. Discussing these options with your healthcare provider, along with appropriate testing, is the best way to approach this.

Functional Medicine Treatment for Hormone Imbalance

Utilizing integrative functional medicine for optimizing hormones can improve a woman's well-being. Here are some ways to support hormonal imbalances holistically.

How to Balance Hormones Through Diet

Our hormones can be influenced by what we eat. Consuming foods that are anti-inflammatory- such as low glycemic carbohydrates, non-processed, and whole food macronutrients, is a great guideline. One review of studies on the Mediterranean Diet for menopausal women found that following this nutrition plan resulted in improvements in many health parameters. Pertaining to hormone imbalances, women in one study saw significant improvement in night sweating and hot flashes. When it comes to supporting hormones in perimenopause and menopause, protein intake, omega-3 fatty acids, and fiber are all important to consume in adequate amounts. Beans, legumes, wild-caught salmon, eggs, and Greek yogurt are all good options for food that will fall into these important food categories.

Hormone Balance Supplements

In addition to a healthy diet, the following supplements can also help with hormonal balancing:

Black Cohosh for Hormone Balance

Actea racemosa commonly known as Black Cohosh, is an effective botanical to use for symptoms of menopause. Literature on this botanical describes common uses, which include effectiveness in the treatment of vaginal dryness, heart palpitations, mood changes, sleep disturbances, hot flashes, and night sweats. While there are mixed results in evidence-based studies for this plant, it is a traditionally used botanical for estrogen deficiency. Standard dosing for Black Cohosh extract is 40 mg to 128 mg per day for up to 12 months.

Bacopa Monnieri for Stress Management

This botanical is typically used for cognitive enhancement but also has a role in stress reduction. A small-scale study looked at the benefits of Bacopa and found a reduction in cortisol levels and an increase in positive mood one and two hours after taking this plant extract.

Curcumin for Autoimmunity

This active constituent, Curcumin, comes from the turmeric plant. It’s known to have a positive impact on autoimmune conditions by regulating inflammatory cytokines that influence immune cells and cause destruction. Science still has a ways to go in figuring out exactly what dose is necessary to achieve the most optimal Curcumin immune system modulation, but this is a promising botanical for immune regulation.

Magnesium for Reproductive Processes

This mineral is responsible for more than 600 enzymatic processes in the body, including hormonal reproductive support. In postmenopausal women, observational studies have seen a correlation between low magnesium levels and mood disorders. There has also been an association between lower serum magnesium and low bone density. Evidence suggests that Magnesium Oxide supplementation can also help reduce hot flashes by up to 50%. Supplementing with magnesium can be tricky because there are many forms of magnesium. Working with your holistic provider to find the right form and dosage is highly recommended.

Complementary and Alternative Medicine Hormone Balance

Below are some examples of beneficial complementary and alternative medicine hormonal balancing treatments:

Additional Micronutrient Support

Depending on your age and reproductive state, nutrient therapy could be helpful. Making sure you are getting adequate micronutrients like Vitamins D, A, C, and B12, along with Calcium, Zinc, and Iron, are all important to maintaining health. Here is a helpful resource to determine how much of these micronutrients you should be consuming daily.

Acupuncture and Yoga

These integrative interventions are both helpful in supporting hormone health. Women entering menopause, or are postmenopausal, could benefit from the mind-body practices of yoga. Acupuncture is also a great tool for stress management and has the potential to decrease hot flashes and mood disorders brought on by menopause.

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Summary

Supporting women through and after menopause can be life-changing. Addressing symptoms like hot flashes, vaginal discomfort, and irritability are just a few of the ways holistic doctors can help ease the burdens of menopause. It's good to know all your options for supporting your hormone levels. Getting appropriate lab tests will inform you and your doctor of what the next best steps are. Whether it be HRT, natural remedies, or a combination of both, knowing that you have options and support is beneficial to your postmenopausal outcomes.