Stages of Menopause

I’m sure you don’t have to think too hard to name someone you know that has (or had) cancer. It simply seems to be a sad fact of life nowadays. And you can likely narrow that list down by type of cancer. For the next couple of weeks, I’d like to focus on one form of female cancer that has touched my family: ovarian cancer.

One of my mother’s closest friends is Connie. I grew up listening to them giggle and plot throughout my entire childhood. I ate dinners at Connie's house and had sleepovers with her daughters. In fact, I’m friends with them on Facebook to this day.

Several years ago, my mother called me with very distressing news—Connie had ovarian cancer. What a shot that was. This is one of the wittiest, life-loving, fun people I knew. How could this happen to her?

While I don’t know the exact reason in Connie’s particular case, I do know that estrogen dominance is a major risk factor for ovarian cancer. To fully understand why this is case, you have to look at what happens during a normal menstrual cycle and how that changes as you get older.

When you are in your teens, 20s, and even 30s, your normal reproductive cycle begins with signals from the hypothalamus and pituitary glands. These glands secrete a hormone (called FSH), which stimulates the follicle surrounding each egg in your ovaries and causes an egg to mature. During this process, your ovaries produce a powerful form of estrogen called estradiol, while your adrenal glands produce a lower-octane form of estrogen called estrone.

At mid-cycle, a second hormone called the luteinizing hormone (LH) is produced by the pituitary gland. LH triggers the egg to be released from the ovarian follicle. It also increases the synthesis of prostaglandins, short-lived hormones needed for ovulation. Once ovulation has occurred, the egg leaves the ovary and travels down the fallopian tube to the uterus.

Both estrogen and progesterone are produced during this second half of the cycle. If the released egg isn’t fertilized, both estrogen and progesterone production decline rapidly, triggering menstruation at the end of the monthly cycle. Thus, estrogen is produced during the entire menstrual cycle, while progesterone is only produced during the second half of the cycle.

As you approach menopause, this process is even more exaggerated. Although your ovaries and adrenal glands continue to produce a lower potency estrogen (estrone), and some estriol (a weaker form of estrogen) is produced by your liver, the amounts don’t support your systems the way your premenopause hormone production does. During this process, four things happen simultaneously:

• your ovaries age and shrink;
• they are less responsive to the hypothalmic-pituitary signals;
• you have fewer eggs to mature; and
• the eggs you have left are older and less healthy.

In an effort to bring your cycle back into balance, your brain’s triggering signals increase as much as ten-fold, trying to stimulate ovulation. During the early stages of menopause, this becomes more and more difficult to achieve. While estrogen production declines significantly, your progesterone levels decrease much more significantly, with production almost ceasing completely. This can lead to estrogen dominance, and consequently, put the health of all of your tissues—especially your reproductive organs—in jeopardy.

That’s because research has shown that unopposed estrogen levels may be carcinogenic to estrogen-sensitive tissues such as the ovaries, and may be a key cause of most female cancers.

If future blogs, I’ll discuss the nutritional and emotional steps you can take to keep estrogen levels in balance and reduce your risk for both estrogen dominance and ovarian cancer.

In the meantime, you can try using natural progesterone to balance your hormone levels. A typical dosage of natural progesterone cream is 1/4 to 1/2 teaspoon applied to any clean area of the skin once or twice a day.

If your menstrual periods are regular, Dr. Lark recommends using progesterone cream about 10 days before the expected start of your period. However, if you suffer from heavy or irregular menstrual periods, apply progesterone cream from day 12 to day 26 of your cycle.

If you are experiencing menopause symptoms and using some sort of estrogenic support, natural or otherwise, Dr. Lark suggesst using natural progesterone three weeks a month, with one week off.

“Corby” asked a question related to my post about the use of melatonin for insomnia. The questions was does melatonin increase or cause depression. The short answer is…maybe, but not likely.

Several studies have confirmed that people who suffer from depression have low levels of melatonin (Lancet, 1979) (Biol Psychiatry, 1984). Other studies have linked depression to a delayed melatonin cycle (Psychoneuroendocrinology, 2004).

Melatonin is produced from serotonin and secreted by the pineal gland. Its secretion takes place at night and is inhibited by light. As such, it sets and regulates the timing of your body’s natural circadian rhythms, such as waking and sleeping. When this cycle is delayed, depression and depressive symptoms can occur.

This cycle is particularly affected during early menopause and, in fact, during all stages of menopause. As you get older, you produce less and less melatonin. Melatonin is produced from serotonin, and serotonin production is stimulated by estrogen. Low estrogen levels equates to low serotonin, which results in low melatonin.

As you can imagine, there is research to suggest that taking supplemental melatonin can help treat mild depression (Psychiatry Research, January 1998), including depression related to menopause and even premenopause. However, there are a few studies that have shown that melatonin can have a negative effect on depression (J Psychiatry, 1976).

Though the studies are small in scope and often include a small number of trial participants, it is always best to err on the side of caution. As the University of Maryland Medical Center advises, “Melatonin should be used with caution in people with depression and should be appropriately timed with…sleep-phase changes. Disruption of normal circadian rhythm by poorly timed melatonin administration may worsen depression."

In the May 8, 2009 issue of Menopause, there were two powerful studies that looked at the use of intravaginal DHEA to treat vaginal atrophy.

The researchers explained that DHEA, the “exclusive source of sex steroids in postmenopausal women, is already decreased by 60 percent and continues to decline at the time of menopause.” For this reason, they wanted to determine if intravaginal DHEA could alleviate the symptoms of vaginal atrophy, just one of the effects of menopause.

After 12 weeks, researchers found that daily intravaginal DHEA at doses of 3.25–13 mg was able to “rapidly and efficiently achieve correction of all the signs and symptoms of vaginal atrophy and improve sexual function and caused no or minimal changes in serum sex steroid levels, which all remain within the normal postmenopausal range, thus avoiding the risks of all estrogen formulations.” In other words, DHEA did not raise estrogen levels, which is good news for women who are sensitive to estrogen, or whom have cancer or blood-clotting risks.

Natural Hormone Levels

This is all great news! DHEA has been referred to as the “fountain of youth hormone.” DHEA is one of the five major sex hormones. It is made from pregnenolone, a steroid hormone made from cholesterol that is the precursor to all the other sex hormones.

Pregnenolone converts to the other four sex hormones (DHEA included) via two different pathways. In the first, pregnenolone is converted into DHEA, which is then converted into testosterone and subsequently estrogen. In the second pathway, pregnenolone is converted into progesterone. The progesterone is then converted into testosterone and, finally, into estrogen. This pathway takes place during the first half of your menstrual cycle, when estrogen is the dominant hormone.

In the second pathway, pregnenolone is converted into progesterone. The progesterone is then converted into testosterone and, finally, into estrogen. This pathway occurs during the second half of the menstrual cycle, when progesterone and estrogen are both dominant.

When you are in your reproductive years, or even during premenopause, you experience both pregnenolone pathways. However, once you enter the later stages of menopause, you only go through only the DHEA pathway and not the progesterone pathway. This is one reason why estrogen levels are so much lower during menopause.

DHEA Eases Menopause Symptoms

Low serum (or blood) levels of DHEA have been associated with risk of heart disease, cancer, and immune-related conditions. Conversely, as the study shows, supplementing with DHEA helps with vaginal atrophy, as well as other menopause symptoms, including poor memory, joint pain, increased body fat, insomnia, and more.

According to Dr. Lark, women looking for menopause relief should take 15–25 mg of DHEA before bed. Be careful not to take more than this, as overdosing may result in increased levels of testosterone, which can lead to acne, increased facial hair, or deepened voice. It can also lead to increased estrogen levels, which can cause sleep disturbances, fatigue, anxiety, and irritability.

As is the case with any hormone replacement, you should have your hormone levels checked before you take DHEA. If your levels are low (below 130 ng/dl in blood; under 40 pg/ml in saliva) and you choose to take it in supplemental form, start with the lowest dose, and increase as needed, being careful not to exceed the abovementioned dosage.