Most women who come and see me experience many menopause symptoms at once like hot flashes, low libido, night sweats, insomnia, vaginal dryness, sudden weight gain, and brain fog. They ask their doctors to run blood tests and when the results come back they’re told, “Everything looks fine and your labs are normal for your age.”
But normal does not mean optimal. Normal in this country means you’re struggling with weight, are either on a blood pressure medicine or Statin drug (or both), and Prisolec, an acid blocker, because you’re having reflux. At night you use a CPAP machine and maybe you’re also taking a sleep medication or antidepressant.
Historically, you’ve also been on five to ten diets and recently you’ve tried keto and Whole 30 and still the needle won’t budge. You notice that what worked in your 20s doesn’t work in your 40s and 50s and it seems like overnight you’ve put on10 to 20 pounds. What gives?
Welcome to the hormonal roller coaster ride that starts in perimenopause and takes you through menopause.
Perimenopause begins before a woman officially reaches menopause. This stage can last nearly a decade, and most of us have zero idea of what lies in store. Our mothers never told us, and our doctors don’t have much to offer in terms of relief, aside from prescribing birth control. Truth is, we all have suffered in silence without a clue about how to get some blessed relief.
I like to think of menopause like this: You are backing out of your period and your body’s as confused about what to do as when you went into menstruation in the first place. Your periods weren’t always regular then. You had mood swings like no one’s business, and you never knew exactly what to expect. Except now, your body’s telling you, “Time’s up! The baby making shop is closing (even if you’ve never had children), so last call everyone!”
You are now on a rollercoaster ride of fluctuating estrogen and progesterone. Hold tight, because your ovaries are in flux with quick drops and steep rises in hormone levels that cause your symptoms. And because women have estrogen receptors all over our bodies, every organ system can be affected by the changes occurring in our ovaries. No wonder we experience so many frustrating symptoms! Your period doesn’t show up on time anymore, you skip it altogether for a month or two, and it can either get shorter and lighter. Or, wait for it, you start to clot heavily with no apparent warning (“Perfect for those times at the beach or wearing white pants to a summer party!”, said no one, ever).
This Girl is on Fire
If you’ve ever had a hot flash, you know it can feel like a sudden overwhelming blast of heat extends from your forehead to your toes and leaves you soaking with sweat. (If you’ve never had a hot flash, think of it as shoveling coal into Dante’s Inferno and sweating like a hairy beast.)
You’ll also notice that you can’t sleep well past 4:00am, you feel exhausted, and develop brain fog. Your hormones now are mixing up your body’s temperature regulator (the hypothalamus). You can experience hot flashes all over your body or in just one area, but the extreme temperature change is wickedly uncomfortable no matter where you feel it.
Your face may also flush and turn red and blotchy. Or, you wake up in the middle of the night drenched in so much sweat, you can wring your clothes out. Left untreated, hot flashes can last for a couple of years or more after menopause; I’ve treated numerous women in their 60s and 70s who were still having flashes long after their periods were gonesies.
Menopause, by definition, means you’ve gone 12 months without a menstrual cycle. Some of us will start and stop our periods for years wondering if our menstrual circuit system has gone awry. Some of us will go 6 months without a period, only to have Flo show up out of the blue. Regardless, every time you restart your period and have a cycle, you’ll also need to restart the menopause countdown clock.
Some women go through menopause super fast like a high-speed train moving through a narrow passage. For other women, menopause is slower and has more ups and downs.
Caution: Speed bumps ahead
Some of the signs and symptoms you may notice during the transition are an increase in irritability and much more irregular periods. Periods start getting shorter and closer together or you might skip a month sporadically here and there. Your libido may also take a nosedive with vaginal dryness and you put on 10-20 pounds practically overnight.
Before you face plant into a tub of onion dip and chips from depression and worry, do not despair! I help women like you navigate through these stages all the time and am here to help make sure that your mind and body feels as good as possible throughout all these changes. We’ll put all the puzzle pieces together to help you understand what’s happening here.
Do you got the Menopot?
A menopot is a special kind of muffin top that happens after the age of 40 when women enter menopause. Many of us experience weight gain (and feeling like we gain weight just by looking at food), clothes that fit differently (or not at all), low libido, and brain fog.
What is the reason for that damn menopot? It all starts with gut health. The gut has a huge influence on our hormones. When I began my practice, hormone testing on women going through menopause was the gold standard until I realized that gut health is also crucial in helping people get their hormones back on track. The healthier your gut function going into menopause, the better your experience will be throughout menopause.
Our small intestinal tract has its own endocrine organ of good, healthy bacteria called the microbiome with bacteria and funguses and viruses and trillions of bacteria that make up our human genome. The gut microbiome comprises the collective genome of microbes inhabiting the gut including bacteria, viruses, and fungi. The human intestine harbors trillions of bacteria which constitute more genome than all the human cells in the body. Pretty cool, right?
Take a wild guess as to what regulates estrogen levels….
Yup, you’re right, It’s the bacteria in our guts!
In fact, a collection of bacteria in the gut called the estrobolome metabolizes the body’s circulating estrogen. In a healthy and balanced gut, the estrobolome maintains estrogen balance, which in turn impacts weight, libido and mood. So optimizing our gut health is key to keeping our hormones in balance.
Buuuuut, if your gut is out of whack you can have either too much or too little estrogen and a wicked time starting menopause. (And also an increased risk of osteoporosis, obesity, and cardiovascular disease.)
And to make things worse, low estrogen can also create gut symptoms like IBS, bloating, and weight gain, too! This is why even if you’ve had a partial or complete hysterectomy, you can still have menopausal symptoms.
Gut health is so vital to our health because the microbiome has many functions:
- Makes and regulates hormones and neurotransmitters
- Nutrient absorption
- Immune function
- Regulates estrogen levels in the body
- Fends off pathogens and parasites and keeps healthy bacterial balance in check
Estrogen and progesterone fuel the good bacteria in our guts. Without adequate levels we can develop dysbiosis, and its wide range of digestive disturbance symptoms including diarrhea, cramping, constipation, bloating, and indigestion.
When the gut microbiome is healthy, the estrobolome produces optimal levels of an enzyme called beta glucuronidase. As the liver metabolizes estrogen, it delivers this conjugated estrogen to the bile for excretion into the gut.
A healthy estrobolome minimizes reabsorption of estrogen from the gut and instead helps you poop it out. However, if you’re constipated and not pooping daily, or have an excess of bacteria producing beta glucuronidase, you can keep recycling estrogen in the gut and become estrogen dominant.
High beta glucuronidase levels can lead to…
- Metabolic syndrome
- Estrogen-related cancers (breast and prostate)
- Mood disturbance
- Heart disease
What happens to the gut during menopause? With estrogen decline, there is…
- Increased gut permeability
- Bloating, constipation, reflux
- Less bile production to help us break down fats and detoxify estrogen
- IBS symptoms
- Thinning of the mucosal lining of the gut due to estrogen decline
- Decreased calcium absorption (rapid bone loss)
- Estrogen regulates cortisol so once estrogen begins to decline, cortisol levels rise and often lead to anxiety and a cortisol belly
- High cortisol slows down the digestion of food which leads to digestive and gut imbalances and constipation
- Brain fog, anxiety and depression, poor energy, and insomnia
Esther Blum, MS, RD is the bestselling author of Cavewomen Don’t Get Fat, Eat, Drink and Be Gorgeous, Secrets of Gorgeous, and The Eat, Drink, and Be Gorgeous Project. She currently maintains a busy virtual practice where she helps women balance hormones, lose stubborn body fat, and treat the root cause of health struggles. Her new book, See Ya Later, Ovulator! was released on October 4th. Learn more at estherblum.com.