Menopause & Hormones The impact of hormonal balance on our well-being.

Contents 1. The Menopause: In Summary.................................................... 2 Changes in the Body .............. Fehler! Textmarke nicht definiert. Changes in Quality of Life............................................................. 2 2. Symptoms and Complaints of the Menopause ........................ 2 3. What causes Menopause?......................................................... 3

In this brochure we have compiled extensive information on menopause. Learn how different hormones interact with each other and how this interaction affects the body; what changes the female body goes through before and during the menopause; and what effect this may have on our mental and physical condition.

The Monthly Cycle Before Menopause ... Fehler! Textmarke nicht definiert. The Production of Oestrogen and Progesterone during the course of Life ........................................................................................... 3 4. Balanced Hormones and Weight Loss ..................................... 4 Oestradiol and Progesterone .. Fehler! Textmarke nicht definiert. Testosterone ................................................................................ 5 Cortisol and DHEA ....................................................................... 6 5. Menopause and Insomnia ......................................................... 6 Oestradiol and Progesterone ........................................................ 6 Other Hormones ........................................................................... 6 6. Options for Action ...................................................................... 7 7. Self-test ....................................................................................... 8 8. Meno

Balance Test-Kit ............................................................... 9

Literature Sources ....................................................................... 10 1

Changes in Quality of Life

1. The Menopause: In Summary Changes in the Body For all women, menopause is, sooner or later, a normal part of their lives – but ‘normal’ does not mean that this part of a woman’s life passes unnoticed or without symptoms. The menopause usually lasts for around two years and during this time the body’s hormone production is changed dramatically: the ovaries reduce their hormone production a little at a time until they produce around 90% less than they did before. At first only the production of progesterone is reduced, then the production of oestrogen until, finally, periods stop completely. According to the NHS, the average age for a woman to reach the menopause in the UK is 52 but it can also occur sooner or later than this: If a woman experiences the menopause before the age of 45 it is known as a premature menopause.1 Medical procedures, such as surgery or chemotherapy, can induce premature menopause. From a medical point of view, women are considered to be going through the menopause if they have not had a period for over a year and a gynaecologist could diagnose it based on certain hormonal values, for example on the basis of follicle stimulating hormone, luteinising hormone and sex hormone binding globulin.


Although the experience of menopause differs from woman to woman, this stage of life is perceived by many women to be burdensome. This is due to the menopausal symptoms associated with hormone deficiency which can affect women in different ways. While some women experience very few symptoms during the menopause, approximately half of women at this stage of life will suffer moderate to severe menopausal symptoms. The absence of menstruation caused by the altered hormonal balance is often difficult for women to come to terms with as it signifies the loss of fertility – many women, whether consciously or subconsciously, consider menstruation to be an integral part of their femininity. During the menopause it is not just hormones that are thrown off balance, many women feel out of balance in themselves: Suddenly the body you have always known is no longer the same.

2. Symptoms and Complaints of the Menopause        

Itchy and dry mucous membranes (this can cause pain during sexual intercourse; dry eyes, nose and mouth Nervous tension Hot flashes and night sweats Forgetfulness, dizziness, and lack of concentration Loss of head hair; increased facial hair growth Water retention and weight gain Sleepiness and fatigue Mood swings: many women become tearful, irritable, aggressive, or depressed. This can have an adverse effect on relationships 2

Osteoporosis Figure 1: Cycle-dependent fluctuations of oestradiol and progesterone. From R. J. Huskey, Virgina University.

Just a single one of these symptoms can have a negative impact on a woman’s quality of life but, unfortunately, many of these symptoms come together causing those affected to suffer greatly. There is good news, however: With proper treatment, not only can these symptoms be alleviated, but their causes can be treated directly.

3. What cause Menopause? The Monthly Cycle before Menopause In order to understand the changes the body undergoes during the menopause, it is important to understand what ‘normally’ happens in the body prior to this upheaval.

During the fertile years of women two hormones are significantly involved in the menstrual cycle: oestradiol and progesterone. As can be seen in Figure 1, oestradiol, an oestrogen from the oestrogen family, is dominant in the first half of the cycle. Oestradiol is the fertility hormone and is responsible, among other things, for the female figure – for example, breast growth and the maturation of the body from girl to woman; the elasticity of blood vessels; and especially for the maturation of egg cells and the monthly development and protection of the endometrium in the first half of the cycle which it prepares, along with progesterone, for the plantation of a fertilised egg. In addition, oestrogens provide for the growth of healthy skin and hair; make the skin glow; keep the eyes and mucous membranes moist; promote clear thinking; and have a stabilising effect on the female mood. In a typical 28-day cycle the lowest level of oestradiol is measured during menstruation. Its value increases until ovulation, when it reaches its peak, and then decreases again slowly until rising briefly to reach a second, small peak at day 21 of the cycle. If no fertilisation takes place, the oestradiol decreases continuously until the onset of the period. In the second half of the cycle, progesterone levels rise above those of the oestradiol (see Figure1). Progesterone, also called the corpus luteum hormone, is produced shortly after ovulation by the corpus luteum, or yellow body (a temporary structure which develops in the ovary each cycle), to protect the uterine lining and prepare the uterus for a possible pregnancy. If no fertilisation takes place, the 3

progesterone levels drop after reaching a peak around day 21 of the cycle. The uterine lining breaks down and menstruation is initiated. A new cycle begins again.

The Production of Oestrogen and Progesterone during the Course of Life Figure 2 shows the typical oestrogen and progesterone levels over the course of the female life cycle, from childhood to menopause. As can clearly be seen in the graph, the level of oestrogen and progesterone production by the time a woman reaches the menopause is extremely low.

ideal rate found in women between puberty and the age of 30. From the mid-30s onwards, the performance of the ovaries diminishes and ovulation becomes more irregular. In cycles with irregular ovulation, less progesterone is produced and in cycles with no ovulation, no progesterone is produced. As a result of the declining levels of progesterone, the menstrual cycles become shorter. The lack of progesterone leads to a hormonal imbalance in favour of oestrogen – this is called an oestrogen dominance. Figure 3 shows how an oestrogen dominance can occur in relation to a progesterone level Ovulation Oestrogen (Oestradiol) Progesterone – Normal Progesterone – debased Level = Oestrogen Dominance

Oestrogen level Progesterone level End of Menstruation

Start of Menstruation

that is lower than normal. Childhood

Teenage Years




Figure 2: The oestrogen and progesterone levels during the life cycle of women. From Prior (2006): Lost perimenopause. J Reprod Infant Psychol 2006 November, 24 (4) : pp. 323-335.

Figure 3: Cycle-dependent fluctuations of oestradiol and progesterone - normal and oestrogen dominance. Following R. J. Huskey, Virgina University.

Long before menopause, usually from around the second half of the pre-menopause stage (when a woman is roughly between 30 and 50 years of age), the formation of sex hormones decreases from the

An oestrogen dominance occurs when the ratio of the progesterone and oestrogen values changes in favour of oestrogen. Since it is ratio of the hormones that is important, an oestrogen dominance can occur despite no change in the oestrogen levels themselves. An 4

oestrogen dominance constantly increases in the years leading up to the menopause because of declining progesterone production (see Figure 2).

Weight problems can arise due to poor nutrition, lack of exercise, illness or psychological stress - but they can also be caused by hormonal imbalance.

Symptoms associated with an oestrogen dominance can include: water retention, tenderness of the breasts (pain and swelling), cysts and fibroids, painful periods, depressive moods and anxiety. During the transition phase to the menopause (peri-menopause), irregular cycles become longer and women may not experience a period for several months. When the menopause arrives, usually around the age of 52 for UK women, the ovaries begin to reduce the production of oestrogen completely. After the menopause, the values of both oestrogen and progesterone reach their minimum level.

Hormones play a significant role in regulating the metabolism and supplying the body with energy. If all of our hormones are balanced correctly our bodies are healthy and can function properly. If the levels of one hormone change, however, it is not only the value of that particular hormone that changes, but its relative value to the level of the other hormones with which it interacts. This means that hormones can fall into relative excess or deficiency, despite their values remaining unchanged. Unfortunately, there are a variety of hormones that can cause wait gain when they are not in balance.

4. Balanced Hormones and Weight Loss

Oestradiol and Progesterone

From around the age of 40, a woman’s figure begins to change and it becomes more difficult to lose weight. Even if they play sport or diet, it becomes very difficult, impossible even, to shift the pounds. Diets tend only to lead to a breakdown of muscle mass instead of fat – a vicious circle because it is, after all, muscles that burn fat, even at rest. Thus, once the diet is over, the weight piles back on again, often more than before, because muscle mass was reduced by the diet – hence, the famous “yo-yo” effect. For this reason a balanced diet should always be accompanied by exercise. After 40, however, even this healthy lifestyle often fails to bear fruit for many women. Why?

Oestradiol and progesterone are particularly affected during the menopause, as described above, with both hormones, but particularly progesterone, being reduced dramatically. As well as a reduction in the values of both hormones, a relative excess of oestradiol forms due to the more rapid reduction of progesterone – this is often referred to as menopausal oestrogen dominance. This adverse ratio of oestradiol and progesterone can cause loose connective tissue, tenderness of the breast (pain and swelling), and water and fat retention - particularly around the thigh and buttock area. Moreover, it can disrupt sleeping patterns, resulting in daytime sleepiness, and can cause restlessness, depression and anxiety since progesterone, a natural mood enhancer and antidepressant, is 5

no longer being produced in sufficient quantities, or even at all. While oestradiol is in excess in comparison to progesterone, it too is reduced from its usual values. The above symptoms are thus amplified as a lack of oestradiol can also lead to sleep disturbances, depressive moods and seemingly unexplained weight gain.

Testosterone Oestradiol and progesterone are not the only hormones that can cause weight gain during the menopause. Testosterone, for example, is also found in the female body and plays a major role in fat burning and the prevention of cellulite. During the menopause, testosterone levels can become unbalanced: too much testosterone in relation to oestradiol can enhance facial hair growth; too little can prevent weight loss, cause anxiety and depression, and a loss of libido.

Cortisol and DHEA Two additional hormones that can affect weight gain around the time of the menopause are the stress hormone, cortisol, and the cortisolbalancing hormone, DHEA. Too much stress, whether psychological (positive, as well as negative, stress – for example, the excitement triggered by having a wedding to plan) or physical (inflammation or illness, for example), ensures high cortisol levels. Cortisol raises insulin levels which, in turn, release carbohydrates (sugars) for energy. If the energy released in the form of sugar is not consumed, for example by physical activity, it is converted and stored as fat in the body. Cortisol levels rise with age as inflammatory processes

become more frequent. As well as this, the values of the cortisolregulating hormone, DHEA, which boosts fat-burning – especially on the belly, start to decrease with age after we reach 25. This means that, with age, cortisol increases as DHEA declines, driving a buildup of fat around the abdomen. It is clear that unbalanced hormone levels can be the cause of weight gain. Trying to lose weight without balanced hormones is unlikely to work – hormonal balance is essential for effective weight loss.

5. Menopause and Insomnia Sleep disorders can have various causes, but it is useful to consider the hormonal connection to sleep problems because excesses or shortages of certain hormones can have a negative impact on sleep patterns and sleep quality: oestradiol, progesterone and DHEA can often be the cause of sleepless nights as we age.

Oestradiol and Progesterone Low oestradial and progesterone levels can lead to sleeping problems and poor quality sleep. Those affected often complain of light sleep that does not feel restful. They are not awake but do not reach deep sleep phase, which is important for nightly regeneration, leaving them feeling tired even after a night’s sleep. A low oestradiol level can also cause sleeping difficulties and triggers hot flashes and night sweats. Low progesterone can cause restlessness and anxiety. 6

During the menopause levels of oestradiol and progesterone fall significantly (see Figure 1), which is why women are particularly affected by sleep problems at this stage of their life.

Other Hormones In addition to these hormones there are others that have significant influence over our sleep patterns and sleep quality – particularly cortisol and melatonin, the hormones most responsible for a balanced sleep-wake cycle. For more details, please see our information leaflet on sleep. Sleep disorders can be treated naturally if you know which hormones are above or below their normal values. Sleep disorders can significantly reduce our quality of life but they can easily be fixed if we know the causes.

as Black Cohosh and Chasteberry, can also be used to help correct hormonal imbalance. Before you start any treatment you must first determine any shortages or excesses in your hormones, and the extent of these deviations. You may only be offered hormone analysis by your general practitioner if you are under the age of 45 in order to determine premature menopause. An optimal alternative is the hormone test offered by Verisana. Verisana can make a precise determination of current hormone levels using a simple saliva test, the samples for which can easily be taken in the comfort of your home. The Meno Balance test kit measures progesterone, testosterone, DHEA and oestrogens (oestradiol, oestriol).

6. Options for Action The symptoms experienced during the menopause can be ascribed to hormonal imbalance – it is no coincidence that these symptoms occur at exactly the same time as a woman’s hormone levels are shifting considerably. Accordingly, many of these complaints can be counteracted by restoring hormonal balance under medical supervision – for example, carrying out hormone replacement in the form of bio-identical oestrogen and progesterone creams or capsules. These are available in most pharmacies. In this way the actual cause of the symptoms can be treated, rather than just masking the symptoms with external agents. Herbal products, such 7

7. Self-test Never

The following questionnaire is intended to help you decide whether a hormone saliva test would be useful for you. If you have answered 50% or more of the questions with “Sometimes” or “Often” then a saliva test is highly recommended to clarify your current hormone status.




I have hot flashes I have night sweats I have trouble staying asleep My breasts are swollen and painful I feel bloated My skin is dry and itchy I am suffering from hair loss I have difficulty concentrating I am more tired than usual during the day I have trouble remembering things I suffer from depressive moods I feel restless and anxious I feel nervous I am aggressive I have mood swings I need to urinate frequently I get bladder infections easily I experience pain when urinating My vagina is dry I experience pain during sexual intercourse I have little desire for sexual intercourse I have difficulty losing weight even though I do not eat more than before


8. Meno Balance Test-kit £200 (Includes all services, VAT, shipping) The Meno Balance kit measures the hormones progesterone, testosterone, DHEA and oestrogens (oestradiol, oestriol) using a saliva test.

This type of test is recommended by the World Health Organisation (WHO) for the determination of hormones.

This is how it works: 1. You order a test kit in our online shop. 2. We will send the ordered test kit to you. The test kit contains the collection tubes required for saliva collection, a questionnaire, as well as detailed instructions for saliva collection. 3. You collect your saliva sample in the supplied collection tubes and send your samples included in the questionnaire to our laboratory. 4. Your sample is released for measurement in the laboratory after receipt of the invoice. 5. You will receive the results of your hormone analysis, an explanation of the levels of hormones and tips to enhance well-being.

For more information, see Do you have questions? Visit our FAQ section, Or send us an e-mail to [email protected]


Literature Sources Delfs, T. M. et al. (1994): 24-Hours Profiles of Salivary Progesterone. Fertility Sterility, 62: 960 – 966. Heufelder, A.E. (2007): Ergebnisse einer Anwendungsbeobachtung an 2801 Patientinnen zur Hormonersatztherapie mit Utrogest® und Östrogen in der Peri- und Postmenopause. Journal für Menopause, Zeitschrift für diagnostische, therapeutische und prophylaktische Aspekte im Klimaterium; 7 (2): 38-42. Lenton E. A. et al. (1988): Measurement of Progesterone in Saliva : Assessment of the Normal Fertile Range Using Spontaneous Conception Cycles. Clinical Endocrinology, 28: 637 – 646. Luisi, M. et al. (1987): Radio-Immunoassay of Salivary Progesterone for Monitoring Ovarian Function in Female Infertility. Ann. Biol Clin., 45: 449 –452, Mahmud, K. (2010): Natural hormone therapy for menopause. Gynecological Endocrinology, 26 (2): 81-85. Platt, M., Armbruster, J., Armbruster, A.: Die Hormonrevolution: Spektakuläre Behandlungserfolge mit bioidentischen Hormonen bei: Schilddrüsenstörungen – Migräne – Osteoporose – Wochenbett-Depressionen – ADHS – Gewichtsproblemen – PMS – Fibromyalgie – Wechseljahresbeschwerden – Diabetes – zu hohen Cholesterinwerten u.v.a.m. VAK Verlags GmbH: Kirchzarten, 2011. Trinacty, M. et al. (2010): Definition of bioidentical hormones. Canadian Pharmacists Journal, 43 (2). Moskowitz D: A comprehensive review of the safety and efficacy of bioidentical hormones for the management of menopauseand related health risks. Altern Med Rev. 2006 Sept; 11 (3): 208 – 223 Römmler, A. (2003): Paradigmenwechsel bei der Substitution mit Östrogenen. ZS Orthomol Med. 2003; 3: 13 – 17. Römmler, A. (2006): Die Wahrheit über Hormone. München: Südwest 2006. Römmler, A. (2006): Endokrinologische Aspekte der Anti-Aging-Medizin. CME Praktische Fortbildung Gynäkologie, Geburtsmedizin, Gynäkologische Endokrinologie; 3: 18 – 34.