Menopause Hormones and Natural Ways
Interviewer: Gail Edgell
Gail Edgell: What is functional medicine?
Dr. Jackson: Functional medicine, or functional laboratory testing, does just that — it takes a peek into what the body may need to better function, or what aspects of function may be being inhibited through dietary indiscretions, nutrient deficiencies, inhospitable organisms and the like. Functional medicine is based upon the notion that before true dysfunction or disease states take hold — sometimes even prior to an official diagnosis — there are intermediate levels of dysfunction that may only be expressed by one or two symptoms or seemingly unrelated symptoms. Many times with a common origin, these symptoms can be assessed and then corrected via substances in nature or lifestyle changes. Natural substances seem to work to balance these intermediary phases of disease progression better than pharmacological substances, which tend to be much more aggressive and thus associated with side-effects ranging from mild to severe in nature.
When it comes to laboratory work, most familiar to us as patients is the standard blood test. Through this testing, both plasma and cellular components of the blood are assessed. Although the standard blood test offers us great benefits in many areas, blood cells and plasma are sometimes not enough. Sometimes, the depth of information serum tests provide is still not as comprehensive as would be possible had another fluid been analyzed. Attributable to the very nature of blood — maintenance of a tightly controlled, steady state — subtle changes occurring over years of mild dysfunction sometimes do not become noticeable in a blood test until the diagnosis is incumbent. Lab-value normals established for identifying disease, therefore, do not tend to offer insight into optimal-health provision or disease prevention. Additionally, there are other nutrients, byproducts of metabolism, brain chemicals, hormones and digestive secretions that are better analyzed through other bodily excretions, including saliva, stool, urine and hair. Other excretion pathways can sometimes identify metabolic changes better because changes in their levels occur locally.
When it comes to menopause and other conditions of hormonal metabolism, the most commonly assessed bodily fluid or excretion is saliva. Hormones, which are the key signaling and communication messengers between our cells, circulate in the medium of our blood. Instinctively, we know that hormones can be measured in the blood, and most people are familiar with hormones being tested in this fashion. Hormones are very highly active chemicals, and due to the attempt to at all costs maintain a steady state within the blood, hormones circulate in our blood in two different capacities. Ninety-eight to 99 percent of our hormones circulate as bound-up hormones. These hormones are not active — they exist to maintain a sort of reserve functionality. In the other capacity, the remaining 1 to 2 percent of hormones circulate in the active, or bio-available, form of the hormone. The 1 to 2 percent of active hormones are the portion of the total hormones in the blood that are available and ready to communicate with our cells.
Many times, blood tests of hormones such as estrogen and progesterone assess the hormone value in totality, meaning both the free, or active, portion of the hormones and the inactive, or bound, form. Calculating values in this way can result in lab values that do not provide an accurate view of what is going on at the cellular level — or in the case of menopause, what is going on at the level of the ovaries with diminished follicular maturation, or in the bones with osteoporosis, or the vaginal tissue with vaginal dryness or atrophy, or the brain’s heat/thermostat center with hot flashes, etc.
Salivary hormone levels reflect only the active, or bio-available,tissue fraction, meaning this 1 to 2 percent of total hormones. Therefore, levels that are abnormal, or out of range, tend to correlate more closely with a person’s clinical symptoms.
The benefits of salivary hormone testing include the convenience of being able to do it from home or work. It is non-invasive, evading the dreaded needle-stick fear of a blood draw. It is a stress-free procedure with easy-to-follow instructions. It is inexpensive, in many cases. And for certain hormones, it paints a more accurate picture of what is truly going on.
Gail Edgell: Is salivary hormone testing common in menopause? Which hormones are tested?
Dr. Jackson: There is an expectant and natural decline of estrogen, progesterone and testosterone as produced by the ovaries during menopause. However, the natural intelligence of the body has a built-in network of compensatory mechanisms that assist in preventing the decline in hormones from being so drastic. Functional or salivary hormone testing, therefore, fills an important niche in not only assessing the true levels of these active hormones outright but also assessing glitches in compensatory mechanisms such as adrenal function and liver function. In some women, it is the inability to efficiently compensate that may be at the root of the unbearable symptoms experienced during the menopausal transition.
Menopausal symptoms can often be categorized by imbalanced levels of each of the hormones, individually. However, as previously mentioned, the bound, or reserve, portion of the hormone does not provide us with much information. So it is the active form that is important to assess in determining whether the levels are too high or too low.
Gail Edgell: Which symptoms are attributed to drops in which hormones?
Dr. Jackson: Too-low levels of estrogen or too dramatic of a drop in the levels of estrogen — from onset of the reproductive years until menopause — tend to be associated with symptoms such as insomnia, vaginal-wall thinning and drying, higher risks of cardiovascular disease, decreased bone density and osteoporosis as well as hot flashes and night sweats.
Too-low levels of testosterone and DHEA, a precursor to testosterone, are associated with lowered libido, decreased stamina, decreased muscle mass, insulin resistance, depressed mood, anger and irritability
Higher-circulating levels of active testosterone with lower levels of bound hormones can be associated with hirsutism, or male-pattern hair growth, as well as male-pattern balding.
Progesterone imbalances are identified as causes of heavy bleeding, longer cycles and mood changes.
Gail Edgell: You mentioned that a woman’s body has mechanisms to compensate for declining hormone production. How do they function?
Dr. Jackson: As a menopausal woman begins to experience a decline in estrogen, the body’s compensatory mechanisms kick in to create other estrogenic, or estrogen-like, compounds. The production of other estrogen-like compounds, called estrones, occur as a collaboration between adrenal function, adipose, or fat, tissue, the liver and kidneys. The adrenals are a major source of this menopausal type of estrogen in addition to our stress hormone, cortisol.
Our body tends to be able to compensate less efficiently for the natural decline in estrogen if we have not adapted well to the pressures of long-term stress. Dramatic changes in our cortisol production will lessen the body’s ability to produce this secondary estrogen, making our experience of estrogen loss or withdrawal more dramatic and the symptoms of too-low levels of estrogen more noticeable and bothersome.
Note: This article is an edited transcript of an audio interview. Changes have been made.