154 A Novel Approach to Supporting Hormones in Perimenopause and Menopause (Part 2)

In the last episode, we met Justine. As a reminder, here are a few details about her case.

The Case:  Justine is 44 and dealing with sudden abdominal weight gain. She is also experiencing brain fog which is causing her stress. Her PMS is getting worse and she just doesn’t feel like herself. She saw her gynecologist who suggested birth control and antidepressants. 

 

The Investigation

If you didn’t hear the first part of this story, please go back and give episode 153 a listen. In that episode, I spoke about Justine’s case with Emily Sadri, an expert in Hormone Replacement Therapy (HRT) and achieving hormonal harmony. Emily is a good friend to the show having previously shared her insights in episodes 141 on Semaglutide (like Ozempic) and Weight Loss and 107 on Birth Control Use with Thyroid Issues.

In the last episode, we talked about the many misconceptions around hormones during perimenopause and menopause. Now, let’s pick up where we left off in the last episode by looking at the timing for hormone support and the physiological restoration protocol (PR protocol). 

When to Start Hormonal Support

A question many women ponder is when to start supporting their hormones, especially as they transition into menopause. Emily noted that the dosage and timing of hormone support depend on whether a woman is still having a menstrual cycle regularly or if is their cycle has become irregular, for example, every 3-6 months. For instance, women who are still cycling (i.e., ovulating) might only need a minimal dosage of estrogen (1-2 milligrams) transdermally daily, while others might require more substantial support. The key is to start with a little bump up and track and monitor for changes. 

The Importance of Monitoring Hormones

One alarming revelation was the number of physicians who prescribe hormone replacement therapy without regular testing. Traditional doctors are often focused on resolving a singular symptom. So, if the dosage reduces, say hot flashes, then the doctor considers the problem solved. But, solving one symptom is not equal to being in optimal health. Emily and I both believe in the value of consistent monitoring. After all, our bodies are ever-changing, and what worked two years ago might not be effective today.

Estrogen and Progesterone: Misunderstood Roles

A common misconception is that only progesterone affects sleep. However, Emily pointed out that estrogen plays a vital role in our circadian rhythms and sleep cycles. In fact, estrogen is a precursor to serotonin, which in turn is essential for producing melatonin, our sleep hormone. It's crucial to maintain a balance between estrogen and progesterone for optimal health. All the more reason to be monitoring hormone levels once treating them, because the individual may misinterpret or miss the symptoms of a hormone imbalance. And, off-balance hormones can work against each other.

Physiological Restoration: Embracing the Natural Rhythm

Physiological restoration is all about mimicking the body's natural hormonal rhythms. This method called the Physiological Restoration Protocol (PR protocol), can be especially beneficial for women in perimenopause or those transitioning into menopause. This method requires the woman to adjust their daily dosage according to where they are in their cycle but it is not as complicated as it sounds since there are generally just two topical treatments to manage. There is an app that helps make it quite easy. The key is understanding that our bodies are all changing and treatment needs to flow with those changes. It’s a spectrum - we’re not robots, explains Emily. It's all about understanding and supporting the body's innate processes.

Utilizing tools like the Dutch test can offer profound insights into hormonal health. For those navigating perimenopause, the cycle mapping feature can be especially enlightening, painting a picture of your hormone fluctuations throughout the month. However, Emily says that the simple Dutch can be misleading, so you want to also look at the organic acids section to get the full picture. 

Starting Hormonal Support Later in Life

If you're approaching your 50s or have already transitioned into menopause, hormonal support may still be a consideration for you, says Emily.  While earlier intervention can often provide smoother results, starting hormonal therapy within a decade of your last period can still be advantageous.

Estrogen Metabolism: It's Not Just About Detox

There’s been a lot of talk among functional medicine practitioners about having patients detox when starting an estrogen protocol. This might include supplements like DIM or Calcium D-Glucarate. However, it's crucial to first understand an individual's estrogen metabolism before diving into detoxification. Emily likes to make sure that patients have proper methyl donation and magnesium levels. She may also look at glutathione but more for those in perimenopause (and takes caution with anyone in full menopause, being sure to monitor symptoms). Supplemental support can be important, but every woman is unique, and what works for one might not be effective for another.

Supplements that Emily considers for perimenopausal and menopause on HRT include:

Fish Oil

B Vitamins (based on methylation)

Zinc

Sulforaphane

In addition to the previously mentioned supplements for peri and menopause:

D-Glucarate

Magnesium

Glutathione 

DIM