Articles by Dr. Lotte Valentin

Menopause Part 1

Menopause is a normal condition that women experience as they age, and is defined as the time period when a woman has not experienced a menstrual cycle for 12 consecutive months and her menses permanently stop. Post menopause is the time period after menopause. Basically, menopause lasts one day, as post menopause is the  next day following the day of menopause; however, the terms are typically used interchangeably. Women usually enter menopause between the ages of 40-60, with the average age being 52, and occurs when a woman's ovaries no longer respond to the signals from the pituitary gland and stop producing estrogen and progesterone.


Perimenopause is the time period when a woman is starting to experience the symptoms of menopause, such as irregular menstrual cycles and hot flashes. This stage typically lasts between 6-13 years. As a woman enters this stage, the hormonal fluctuations which eventually lead to a decrease in hormone levels can cause many women to experience a variety of symptoms.




The first symptoms of perimenopause are usually an irregular menstrual cycle, anovulation (no ovulation) and hot flashes. During this stage, hormones can fluctuate wildly, causing ups and downs of estrogen, testosterone, progesterone and DHEA, which are responsible for a variety of symptoms.


The symptoms that a woman can experience during her perimenopause and post menopause stages are many, and typically include the following:


•    Hot flashes

•    Anxiety

•    Depression

•    Decreased sex drive

•    Vaginal dryness and itching

•    Incontinence

•    Fatigue

•    Dizziness

•    Irregular menstrual cycle

•    Insomnia

•    Joint pain

•    Irritability

•    Facial hair growth

•    UTI, bloating

•    Indigestion

•    Osteoporosis

•    Hair loss

•    Heart palpitations

•    Headaches

•    Memory lapses


Hormone functions:


The hormones in your body have different functions and are regulated via a complex communication between the hypothalamus, pituitary gland, ovaries and adrenal glands. The hypothalamus, which is about the size of a pea, is situated between the thalamus and pituitary gland in the brain and links your nervous system to your endocrine system. The hypothalamus sends signals to your pituitary via a hormone called Gondadotropin Releasing Hormone (GnRH), which then signals the pituitary to release FSH (Follicle Stimulating Hormone) and LH (Lutenizing Hormone). LH and FSH then send signals to your ovaries and adrenal glands to make estrogen, progesterone and testosterone.


As you enter menopause you will start to experience irregular ovulation, which eventually results in anovulation (no ovulation). If you don't ovulate, you are not setting off the cascade of hormonal reactions in your body that will cause you to menstruate. (For more information on how this works, see the previous newsletter on menstruation.) The different hormones in your body play different roles, and all the different hormones need to be in balance in order for the body to function optimally.


When there is an imbalance between the hormones, different symptoms emerge. Many times an excess of one hormone or a deficiency of another may cause the same or similar symptoms, so it is always best to have your hormones tested so that the correct hormone balance can be achieved using either hormone replacement therapy or herbs and supplements.


The functions of the different hormones in a female body can be summarized as follows:


FSH: The Follicle Stimulating Hormone is a marker for ovarian function in women. FSH is released by the pituitary gland and increases during ovulation to make your ovaries produce more estrogen in order to release an egg for ovulation. FSH also increases during perimenopause and menopause. As you age, your body produces fewer eggs and therefore produces less estrogen, causing you to not ovulate and skip your menstrual cycle. When a woman is ovulating, her granulosa cells in the ovaries send a signal back to the pituitary via a glycoprotein called Inhibin B that informs the pituitary to stop sending more FSH in order to control the amount of estrogen the body is making. As ovulation becomes intermittent and eventually stops, there is no Inhibin B signal being sent from the ovaries to the pituitary to stop sending FSH signals. As this negative feedback loop is no longer working, it results in the pituitary continuing to send FSH signals to the ovaries causing a rise in FSH, and can therefore be used as a marker in a lab test as a sign that a woman is entering menopause. 


LH: TheLutenizing Hormone works in conjunction with FSH and regulates ovulation and progesterone in a premenopausal woman. When a woman is menstruating, the increase in LH from the pituitary when the egg has ripened causes an increase in estrogen from the follicles, which creates a positive feedback loop to the pituitary and causes a spike in LH right before ovulation in order to release the egg from the follicles. LH also increases in menopause but not as much as FSH, which is why FSH is what doctors typically look at in order to determine if a woman is in menopause.


Estrogen: Estrogen has over 400 functions in the body, which include some of the following: prevents Alzheimer's disease by stimulating production of choline acetyltransferase; increases insulin sensitivity; maintains muscle tone, skin elasticity and bone density; improves sleep; increases blood flow and decreases plaque in arteries; increases HDL (good cholesterol) and decreases LDL (bad cholesterol); improves mood and energy; reduces risk of cataracts, glaucoma and colon cancer.


Symptoms of excess estrogen include: water retention, poor sleep, headaches, swollen breasts and panic attacks. There are also about 50 chemicals than can mimic estrogen, such as pesticides, synthetic hormones fed to animals, plastics and cosmetics, and can therefore contribute to symptoms of excess estrogen.


When there is a reduction of estrogen a woman may experience some of the following symptoms: decreased sex drive, poor memory, depression, elevated lipids, elevated blood pressure, aging skin, osteoporosis, vaginal dryness, hot flashes and more.


There are 3 different kinds of Estrogen, E1, E2 and E3.


Estrone: (E1) - This is a strong estrogen and an increase is often linked to fibrocystic breasts, uterine fibroids or endometriosis. E1 is the predominant estrogen in post-menopause. E1 is made from androstenedione and E2.


Estradiol: (E2) - This is the strongest of the estrogens and increases the good cholesterol HDL, as well as prevents bone loss; improves skin tone and cognitive function; increases immune response, and is involved in female reproduction, sexual development, arterial blood flow and neurological protection. E2 is made from both estrone and testosterone and is the predominant estrogen before menopause.


Estriol: (E3) - The weakest of the three estrogens, estriol helps oppose cancer cells that can be promoted by the stronger estrogens E1 and E2. E3 is derived from E1 and E2 in the liver. E3 can help alleviate hot flashes and incontinence.


Progesterone: Has a calming effect on mood and is a natural antidepressant. It also promotes sleep and helps balance the effects of estrogen. Progesterone is a precursor to other hormones and also interacts with other hormones in your body like the thyroid. If you are under a lot of stress, you may convert your progesterone to cortisol, which is referred to as the "cortisol steal." The body will use the cortisol for energy to "fight or flee," and this conversion typically happens when a person is under some form of stress, whether physical or mental. Some of the symptoms associated with low progesterone include the following: anxiety, depression, insomnia, migraines, heavy menstrual flow, irritability, mood swings, decreased sex drive and decreased HDL.


Testosterone: Women only have about 5-10% of the amount of testosterone that men do, but it has an important function in the well-being of a woman as it promotes muscle mass and sex drive, as well as bone health. Testosterone can also function as an emotional shield and increase dopamine, as well as decrease excess body fat and help maintain memory. Some of the symptoms associated with low testosterone include: fatigue, poor muscle tone, decreased HDL, thinning of hair, poor skin elasticity, anxiety, poor memory, weight gain, low self-esteem and low sex drive.


DHEA: (Dehydroepiandrosterone) This is the most abundant sex hormone in the body and is primarily made in the adrenal glands. DHEA is a precursor to making testosterone and estrogen. The biochemical pathway in the body goes from DHEA to androstenedione to testosterone to estrogen and the body decides which pathways to take and which of the hormones to produce. Other functions of DHEA include: increasing bone growth, improving brain function and promoting lean body mass, as well as decreasing cholesterol, fatty deposits, blood clots and allergic reactions. Symptoms of too much DHEA include: fatigue, depression, insomnia, mood changes, weight gain, acne and irritability.


The information contained on this site is for educational purposes only.  These statements have not been evaluated by the Food and Drug Administration and are not intended to diagnose, treat, cure, or prevent any disease. Please discuss all your medical issues with your doctor.