• Dr. Tara Tranguch

The Great Pause.

Menopause and Andropause

Fatigue, weight gain, low libido, mood swings… Ugh!


These are a few of the symptoms that can afflict us at mid-life. Our hormones shift pushing women into menopause and men into andropause. Yes, men go through a hormonal life shift too!


Menopause and andropause are a result of multiple hormone levels changing including the well known testosterone, and its downstream metabolites estrogen and DHT. Not as commonly discussed are the changing levels of progesterone, DHEA, luteinizing hormone (LH) and follicle stimulating hormone (FSH).


These hormone fluctuations result in sleep changes, increased fat deposits, anxiety, a greater risk of cardiovascular disease, reduced bone health and an increased risk of dementia. This hormone pause causes a shift across multiple body systems.

It can be a common approach to supplement with the diminished hormone, but this does not address the whole person, and here is why.


Check out this steroid pathway, courtesy of DUTCH Hormone Test. Note the relationships between all our steroid hormones, including cortisol.

When assessing hormonal balance, it is much more effective to look at all the hormone levels and how they relate to each other. This is a test I offer and recommend for men and women approaching menopause and andropause.

(And as an aside, guess where ALL these hormones originate from? The precursor to our steroid hormones is LDL, aka "the bad cholesterol". Not so bad in this case).


Menopause


During menopause, ovarian function decreases resulting in declining estrogen and progesterone. Menopause is diagnosed as the absence of menses for one year. Perimenopause refers to the years before menopause and is characterized by wildly fluctuating hormones.


The final years of perimenopause are when symptoms are the worst, including hot flashes, increased facial hair, and unfortunately hair loss where we want the hair, weight gain, mood changes, sleep disturbances, incontinence, vaginal changes, memory decline, skin and eye dryness, headaches and joint pain. After menopause, due to hormone changes, women are at a greater risk for osteoporosis, cardiovascular disease and Alzheimer’s.


During these transitional years, there are well researched botanical, diet and nutraceutical approaches that can be taken to balance hormones and address symptoms. Some of my favorites include:


1. Soy isoflavones such as genistein and daidzein are phytoestrogens, or plant-based estrogens. This means the structure of the isoflavones are similar to our estrogen and can therefore attach to estrogen receptors and cause a weak estrogenic effect. Phytoestrogens help to both tone down high estrogen and turn up low estrogen in the body. And yes they are safe for breast cancer and other reproductive cancer surthrivors!


Soy isoflavones are effective in lowering vasomotor symptoms such as hot flashes and night sweats, improving vaginal dryness and improving bone health. Soy is also a great food option for lowering total and LDL cholesterol. So throw some roasted soy nuts into your snack rotation!

2. Omega 3 fatty acids include ALA, EPA and DHA. Fish oils are commonly a combination of EPA and DHA. High dose EPA helps alleviate menopause related depression.


Flax seed oil and sea buckthorn oil can increase tear production to relieve dry eye symptoms; and dry eye has been relieved when fish oil is combined with flax seed oil. Quantity and quality of the fish oils is critical for therapeutic effectiveness, so I recommend to work with a naturopathic doctor for your prescription.

3. The roots of the plant Black Cohosh are made into medicine with anti-spasmodic properties for the musculoskeletal and female reproductive systems. It has been well researched for its positive effective on menopausal symptoms of night sweats, hot flashes, depression, and joint pain.


The Eclectics, botanical medicine doctors that later became Naturopaths, used Black Cohosh drop dosing for stagnant depression. This herb shows benefits according to the Menopause Rating Scale within 4 weeks. It pairs nicely with St. John’s Wort and Rhodiola to help with menopause-caused changes in mood. Add in Hops for assistance with insomnia.

Me with two new Black Cohosh plants

purchased at the Pomperaug Valley Garden Club ready to add to the yard.

4. Adaptogens for modulating stress. When we experience chronic low grade stress, we divert our progesterone from making sex hormones to making cortisol. If you refer back to the image above of the steroid pathways, you can see how progesterone could be diverted to cortisol instead of going to testosterone. This is called ‘progesterone steal’.


Adaptogens are herbs that help to support the body’s stress response and nourish the adrenals, which is where cortisol is made. Adaptogens include plants such as Ginseng, Rhodiola, Schisandra, Cordyceps, Eleuthero, Ashwagandha, Tulsi, Reishi and Maca. Each of these plants has a different type of activity in the body, so the selected combination should be personalized to your specific constitution and symptoms.


5. Kava is an excellent herb for reducing anxiety and contributing to improved sleep. Kava is good for chronic anxiety, and also for acute panic attacks with nervousness, heart palpitations, chest pains, headaches and dizziness. And Kava helps with hot flashes as well!


Kava can be taken as a capsule or a tea - Yogi Tea makes a great one that you can buy in the grocery store! Its active ingredient is kavalactones, which can be toxic to the liver if taken in too high a dose for a sustained period of time. So definitely work with a naturopath doctor before taking it in capsule form.

6. Curcumin is a well known anti-inflammatory. It is effective at reducing joint pain, and it is also excellent at reducing hot flashes. Consider Curcumin in cases where menopause brings joint pain and increased inflammation.


7. Maca is a cruciferous root in the brassica family - like a turnip! - that is dried and ground into powder. It was used by the Incan warriors as a natural aphrodisiac to increase libido, strength and endurance. Maca is excellent for improving libido. And interestingly, it has research supporting its effectiveness at restoring anti-depressant induced sexual dysfunction. Maca improves libido within 2 months and improves fertility after about 8 months of supplementation. And it has a nice malty taste that can be delicious mixed with raw cacao.


8. Besides maca, there are other botanicals that are excellent in helping to raise libido. Below is a formula for a Libido Tonic. You can enjoy this with your partner daily.

Libido Tonic: Maca, Damiana, Smilax ornata, Gingko, Scutellaria lateriflora

9. Estriol is the weakest form of the three estrogens and is the form most prevalent during pregnancy. It is an excellent form to use for treating menopause symptoms that affect the genitourinary tract including incontinence, vaginal atrophy, dryness and discomfort during sex. Estriol suppositories can be used safely to decrease UTIs and improve the sexual health of the vagina without increasing levels of estrogen in the body.


10. Hormone Replacement Therapy (HRT) can also be beneficial for alleviating symptoms and reducing potential future health risks such as osteoporosis. It is best to start HRT within 10 years of onset of menopause for the benefits.


There is much more to this discussion including menopause and memory loss, osteoporosis and cardiovascular disease. If you are interested to discuss these topics and your health, please schedule a 10 minute consultation with me.


Andropause


During andropause, testosterone levels decline. This can be due to decreased DHEA, which is made in the adrenals, and/or to an increase in aromatase and 5a-reductase, two enzymes that metabolize testosterone to estrogen and DHT, respectively.


Increased estrogen results in the dreaded man boobs and abdominal obesity. Increased DHT results in male pattern baldness and contributes to Benign Prostate Hyperplasia (BPH). Other symptoms of andropause include erectile dysfunction,

Do not self treat andropause by applying testosterone. If you have an increase in aromatase and or 5a-reductase, you will be driving the pathways towards increased estrogen and DHT and thereby compounding the problem.

Here are a few recommended approaches to curbing the negative effects of Andropause. It is always much more effective to get a personalized treatment plan, so I recommend to work with a naturopathic doctor who is trained to assess all your steroid pathways and provide a personalized treatment plan. Of course, I am a naturopath, so you can see my bias.


Recommended approaches to gracefully go through andropause:


1. Exercise - Research shows moderate intensity exercise for 200-300 minutes/week can improve sexual function, testosterone and weight. Specifically, wall squats are the best exercise to increase testosterone.


2. Add pumpkin seeds to your diet. Pumpkin seeds are a great source of zinc, which is often depleted in men with Benign Prostatic Hyperplasia.


3. Reduce synthetic xenoestrogens. Synthetic xenoestrogens are chemical compounds that mimic estrogens in the body. Sources include BPA in plastic bottles, processed and packaged food, chlorine in dry cleaning and bleaching, creams and topicals with paragons, phthalates in sunscreen, artificial scents etc. These chemicals bind with estrogen receptors in the body resulting in estrogenic effects such as gynecomastia (man boobs) and abdominal weight.


4. Eat organic dairy products - or avoid dairy all together. A 2010 study found cow milk to contain large amounts of estrogen and progesterone. Pediatr Int. 2010 Feb; 52 (1): 33-8 PMID 19496976


5. Reduce stress. Increased cortisol not only increases blood sugar and fat deposits, but it also steals progesterone away from making sex hormones. Reducing the negative impact of stress can be achieved through lifestyle changes, stress management techniques, adrenal tonics, nervine trophorestoratives and adaptogenic herbs.


6. Lay off the beer. Beer is made from hops. Hops, or Humulus lupulus, are estrogenic. Enough said.


7. Add foods that are natural aromatase inhibitors to your diet. Aromatase inhibitors block testosterone from turning into estrogen. Aromatase inhibitors include arugula, pine pollen, red clover, and pomegranate seeds.


8. Cruciferous vegetables also assist the body in getting rid of excess estrogen via the liver detoxification processes. Cruciferous vegetables include broccoli, cabbage, Brussels sprouts and cauliflower.

9. Saw Palmetto and Nettle Root extract inhibits 5a-reductase and aromatase to increase free testosterone. 5a-reductase is the enzyme that metabolizes testosterone to DHT. Excess DHT contributes to hair loss known as male-pattern baldness and BPH.


10. Panax Ginseng and Gingko are two plants that increase Nitric Oxide synthesis. Increasing NO synthesis addresses one of the contibuting factors to erectile dysfunction.


Conclusion


God willing, we will all go through The Great Pause in our lifetime.

Some cultures herald this transition as a rite of passage to a new state of being marked with wisdom, experience, peace and bounty.

Not so much in America, where we tend to grasp for our youth and shun the gray hairs and wrinkled laugh lines. But the transition can be graceful and this next stage in life can be enjoyable.


You can age healthfully and enjoy the fruits of a life well-lived. I want that for you. Believe you can have it.


I offer the DUTCH Hormone Test for men and women to provide comprehensive testing of hormone levels. If you are interested to see if this test would benefit you, please contact me.





Medical Disclaimer: The information on DrTaraTranguch.com, and related blogs and emails, is provided for informational purposes only and is not intended to replace consultation with a qualified health care professional. It is not intended as medical advice and does not create a doctor-patient relationship between you and Dr. Tranguch. It is not intended for use in diagnosing or treating a health problem or disease, or prescribing treatment. Please consult your physician or healthcare professional before taking any medication or nutritional, herbal or homeopathic supplement, or beginning any treatment for any health problem. Information and statements regarding dietary supplements have not been evaluated by the Food and Drug Administration and are not intended to diagnose, treat, cure, or prevent any disease.