Menopause: Your Questions Answered by Naturopathic Doctor, Part 1

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27 Feb Menopause: Your Questions Answered by Naturopathic Doctor, Part 1

Dr. Tasnim Adatya responds to questions about menopause. She is an expert on menopause and a naturopathic physician with 20 years of hormone experience. Please get in touch if you have menopause questions!

Question: How will I know when I’ve finished my menopause? I am 57 and partly confused because I have had Chronic Fatigue since my 20s and the symptoms mimic menopause: night sweats and fatigue. Also my periods stopped and then I had a random period 6 months later.

This is a complex question and a good question because the middle years can be a turbulent time. At 57 you would expect your period to be finished: the average age of menopause in North America is 51. Therefore, 57 is unusual, but not impossible and not unheard of. The yard stick to measure this is if you have a gone a year with no period and then you have a bleed, it is important to see your physician as that would technically be a post-menopausal bleed and require investigation.

Middle years can sometimes be a difficult time because parents may be getting elderly, partners may not be helpful in the home or with day-to-day tasks, we may be find ourselves taking on more responsibility at work, and the kids may also be at an age and stage where there may be different problems in young adulthood. So it can be quite a stressful time, quite a tiring time and we never know if we’re doing absolutely too much.

During the middle years, the adrenals and thyroid can decrease in function and if you are having bleeds, they can be quite heavy and increase the risk of anemia. So there is value in seeing a primary care provider, such as a licensed naturopathic physician, that specializes in hormone health to discuss your symptoms, rule out adrenal fatigue, and possibly obtain a thyroid panel test.

Question: Can natural or bio-identical hormone replacement can help with the hormonal chaos? 

The best symptom that improves with estrogen replacement is hot flashes. So if hot flashes are a problem, then it’s worth considering. Bio-identical progesterone when administered orally can help with night sweats and sleep disturbances due to elevated cortisol (from adrenal fatigue). Intra-vaginal or oral bio-identical progesterone can also help with heavy periods.

There is however a window of opportunity with hormone replacement, it is most effective between the ages of 50 and 60 years old. It’s difficult to start hormone replacement over 60 years of age because there are a different set of risks. But again, it’s worth discussing your options with a primary care provider. What I will say, is this website has a blog that is full of useful bio-identical hormonal information including natural strategies and common sense approaches as well as important medical information. Every woman is encouraged to do some homework, list your questions, and make an appointment with a health-oriented physician to discuss strategies based on: the severity of your symptoms, your risk factors for disease, your lifestyle, and your values concerning how you want to approach your menopause.

Question: I have a partner that won’t admit her symptoms are menopause related. Is there anything I can do as our relationship is on the line.

This is a very good question. Relationship difficulties sometimes surface during the middle years. While the kids are there, most couples soldier on and soldier on. But when the kids leave the home, and partners are left together for more time than they have ever been, stressors can arise. For this reason, counseling can be very helpful. The other thing to say is estrogen does help mood and it helps drive mood, it can also boost well-being.

During the estrogen decline, women can feel grumpy, it’s a bit like PMS but on most of the days. There’s also great variability from day-to-day and that can be part of the problem. So one day you may think, “Oh no I’m fine today” and the following day, it’s a return to that black cloud again.

There is great value if your partner can be supportive and go with you to see your health care provider, because depression in the menopause is a big symptom. What the bio-identical hormone replacement might do if the provider feels it’s the right option, is even out the lows. It just gives a consistent amount from day-to-day, so that you’re not bumping along the bottom all the time: it lifts that hormone level and it lifts mood.

There are some people suffering with depressive symptoms in menopause for whom hormones are not a viable option, for example, breast cancer survivors. Peer-reviewed research has also shown that herbal medicines, omega-3 fatty acids, and amino acids may help boost neurotransmitter (brain chemical) production. There are also a group of anti-depressants called the SSRIs, and there is evidence that they too help in menopause.  No one really knows how they help because it’s a hormone issue, but the evidence shows they do.  Strong evidence also exists for risk-free approaches including lifestyle and diet. Moreover, adopting a healthy diet and lifestyle will have far reaching benefits beyond symptom relief and help with lowering risk of disease and therefore increasing longevity and delaying physical disability.

Question: I’m wondering why I’m tired all the time, despite sleeping well. I find I’m struggling to get out the bed in the morning.

Unnatural fatigue is quite a problem. First of all, lifestyle and exercise is free and effective. Exercise gives us energy, it boosts our serotonin – that feel good factor – and it boosts our whole metabolism. It often gives us company in other people and it’s a general tonic. Thirty minutes five days per week is optimum, but you can certainly do more if you like. Also, exercise alone reduces the risk of breast cancer.

Checking blood markers for thyroid and ruling out anemia is also important. Equally, the adrenals have an increased responsibility for furnishing our sex hormone requirements after menopause and irregular cortisol output can impact quality and latency of sleep as well as daytime energy. It is worth seeing a provider specializing in hormone health to help if the lifestyle measures don’t seem to be impactful enough.

Question: I am 56 years old. I had my last period 6 years ago and I’ve been trying to manage my symptoms independently without any medical intervention. I’ve undertaken major lifestyle changes: I gave up smoking, I did the couch to 5K run, I’m an occasional jogger and go to the gym regularly. I also cut down on sugar and try to get 7-9 hours of sleep. But my main issue is fatigue. I find myself falling asleep in the middle of the day when I’m not working. I want to get out and do things!

What I would say with this query, is think about sleep apnea. Sleep apnea is an interesting condition, it has nothing to do with menopause. But in the night during sleep, sometimes people will breathe less and less, as the breathing gets shallower and shallower, with sleep apnea it can stop for a minute or two and then follow with a big deep breath. The overall effect of that is sitting down during the day and falling asleep. The big worry is falling asleep while driving. There are sleep apnea questionnaires that your health provider would be able to give you and they can provide you with a sleep score or you can ask to be referred to a sleep apnea clinic. 


In part 2, I will continue to answer your menopause questions so keep returning and be sure to read on in the next blog post due out soon!

If you or someone you know would like help sorting out menopause options, feel free to drop me a line on the “contact us” page on this site. I treat patients locally at my Naturopathic practice in Vancouver, B.C. and worldwide via phone or Skype.

To honoring your health potential!

Dr Tasnim Adatya

Licensed Naturopathic Physician, Menopause Clinician, Acupuncturist, Author, and Health Educator



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