A Functional Medicine Approach to Menopause

By Wendy Warner, MD, FACOG, ABIHM

A Functional Medicine Approach to Menopause

All gynecologists are taught that hot flashes and night sweats come from falling estrogen levels. Period. That means that when you go to see your doctor with these complaints, you’ll likely get a prescription for hormone replacement (HRT) and a long talk, since there are issues with HRT.

But stop and think about it: How can it just be from falling estrogen levels? That simply doesn’t make any sense, since every woman on the face of the planet drops her estrogen at menopause … and not all of us flash!  Also, many women continue to flash for years after their last period, long after their estrogen level should be more stable. And many folks can pretty much predict when it will happen: When they get upset, or when they eat something sugary or starchy. Think also about how you feel when you flash – you get hot, you get sweaty, your heart rate goes up, you might feel anxious. Doesn’t that feel more like someone came up and surprised you? Something like a panic attack – the fight or flight reaction? How can this be? 


It’s About More Than Estrogen

The part of our brain that regulates temperature responds to both estrogen and adrenaline (a stress hormone from your adrenal glands). We know that if the adrenaline level is normal (ie. low), then your estrogen level can be high or low, it doesn’t matter – you won’t flash. However, if the adrenaline level is chronically high (i.e. you spend a lot of time stressed out), any drop in the estrogen level will trigger a flash. Since many of us live busy, hectic lives, our adrenal hormones tend to be out of balance, so as soon as our estrogen starts to fall, this cascade of reactions kicks in and we start getting flashes. That’s why it’s important to look at adrenal function as well as estrogen levels when trying to manage menopausal symptoms.

The diet-related flashes are also pretty easy to explain: We know that when we eat sugary, starchy foods, our glucose level goes up. This makes our insulin kick in to control it; when the insulin rises, our cortisol goes with it. Cortisol is a hormone from the adrenal glands, and when it goes up and there’s no estrogen around to balance it, it triggers the same flashing that adrenaline does.

Other nutritional concerns are important in dealing with menopausal symptoms. In order to make hormones effectively, we need a range of nutrients from magnesium to B vitamins, to zinc and selenium. In order for our livers to process our hormones correctly, we need B vitamins, antioxidants like vitamin A and vitamin C, sulfur groups from onions and garlic, and enough protein. Many women will find that, especially early in the menopausal transition, simply improving their diets will be the only intervention they need to do in order to feel better!

Why hasn’t your conventional gynecologist talked with you about these things already? Well, we simply aren’t taught it in school. Nutrition isn’t addressed well in medical school, and although we learn the basic biochemistry of hormone production and metabolism, the treatments we are taught don’t seem to take that science into account. That’s where a functional medicine approach comes in handy. 

Functional medicine allows us to see the big picture and individualize it. Functional medicine practitioners such as myself look for ways to normalize and optimize our body’s own mechanisms, rather than focusing on treating the surface symptoms of any disease or imbalance. We take into account each person’s genetic potential, their lifestyle, and how they are currently expressing any physical imbalances. We then find ways to bring it all back in balance. This takes time and commitment on your part – but it works!

To find a functional medicine practitioner near you, go to www.functionalmedicine.org; for other integrative holistic physicians, go to www.abihm.org

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