It was a massive but. Sandi was a fashion magazine editor who often worked long days and felt a near-constant stress to look fabulous. But early menopause had sabotaged that confidence, leaving her feeling frustrated and confused. It wasn’t just miserable physical symptoms like sleeplessness, brain fog, mood swings, an “arctic level” (as she called it) sex drive, and dreaded hot flashes that she suddenly experienced out of nowhere—Sandi was also going on an emotional and spiritual journey that many women don’t anticipate or experience until later in life. Research shows the decrease in hormones that comes with early menopause also increases your risk2 of premature death, neurological diseases, psychosexual dysfunction, mood disorders, osteoporosis, ischemic heart disease, and challenges with fertility. For Sandi, those symptoms and potential risks came out of nowhere, and she wanted to do everything possible to alleviate them. Researchers define early menopause as the end of ovarian function before age 45, and premature menopause affects about 1 percent2 of women under 40. The first red flag occurs when you start having changes in your menstrual cycles. Women typically report irregular, shorter, or longer periods as estrogen levels nose-dive. Sandi hadn’t had her period in a year, she had nearly zero libido, her energy levels plummeted, and she either had sleepless nights or got really bad sleep. She was also putting on belly fat that she couldn’t lose, and low energy levels left her unmotivated to hit the gym regularly. Understandably concerned and frustrated, Sandi visited her doctor, who ordered some tests to determine whether her symptoms indicated early menopause or another condition. Among those tests included estradiol (to measure estrogen levels), follicle-stimulating hormone (to determine how well her ovaries functioned), and thyroid-stimulating hormone. From her results, Sandi’s doctor diagnosed her with primary ovarian insufficiency or early menopause. Sandi had gone off the pill before I saw her, which had created additional birth control side effects. In my practice, I also see how birth control pills can mask many signs of early menopause. In Sandi’s case, they may have masked the symptoms of primary ovarian insufficiency for years. Because the pill suppresses ovarian function, your ovaries aren’t making sufficient estrogen or progesterone. Instead, the pill provides synthetic estrogen and progestin, which means you still get your periods regularly as part of a withdrawal bleed, not to be mistaken for a “real” period. Because it can mask symptoms, the pill can make diagnosing menopause or (in Sandi’s case) early menopause difficult. When Sandi visited me, I ran some additional tests. They revealed she had Hashimoto’s, the No. 1 cause of hypothyroid disease, where antibodies attack the cells in your thyroid gland and don’t make enough thyroid hormone. We also found that Sandi was negative for 21-hydroxylase antibodies, which causes autoimmune adrenal insufficiency. Approximately 3 percent of women with premature ovarian failure are found to have positive adrenal antibodies. Studies also show5 that autoimmune disorders contribute to 30 to 60 percent of early menopause, paving the way2 for other problems including type 2 diabetes, rheumatoid arthritis, and systemic lupus erythematosus. When you get your period, your hypothalamus sends a message to your pituitary gland, which triggers follicle growth and increases estrogen to stimulate the lining of your uterus to grow and thicken. Declining estrogen levels in early menopause means that process doesn’t happen. Instead, the number of ovarian follicles declines and your ovaries become less responsive to two other reproductive hormones, luteinizing hormone (LH) and follicle-stimulating hormone (FSH). As your ovaries age and release fewer hormones, they can’t effectively regulate estrogen, progesterone, and testosterone. That sends your hormones crashing and has detrimental repercussions. Estrogen levels naturally get lower as you get older, but that doesn’t mean you need to settle with the sometimes-detrimental consequences. From a functional medicine perspective, menopause is more than just estrogen depletion or a cluster of miserable symptoms. Instead, we look at the whole system and all the potential hormonal imbalances. Take your adrenals, for example: When they get out of whack, they can create or exacerbate menopausal symptoms like hot flashes and mood swings. Once the ovaries stop producing hormones, your adrenal glands provide dehydroepiandrosterone (DHEA), which your body converts to estrogen and testosterone. This is why you must be good to those adrenals. A high-sugar, starchy, processed-foods diet places stress on your adrenals and raises insulin, which can also trigger or exacerbate symptoms like hot flashes. Because your ovaries make less estrogen and progesterone, your libido, mood, and exercise stamina can also nose-dive, all of which can leave you feeling more stressed out and anxious and create further hormone imbalances. That domino effect affects other hormones and systems. Thyroid issues and gut issues including leaky gut can all mess with6 your mood, considering that your gut manufactures about 95 percent of your feel-good neurotransmitter serotonin. Insufficient levels of thyroid hormone can also create depression, anxiety, and irritability and pave the way for early menopause. I could go on (hormones are complex and can get messy), but you can see where I’m going: Once a few hormones get out of balance—in Sandi’s case, estrogen and insulin were the heavy hitters—others quickly follow. Sandi’s doctor suggested hormone replacement therapy (HRT) or estrogen replacement therapy (ERT), which can improve mood changes and other symptoms related to low estrogen levels during early menopause. Sandi wanted a more holistic approach to treat her symptoms, which is why she visited me. “There’s a lot you can do to eliminate symptoms of early menopause and reverse primary ovarian insufficiency,” I told Sandi. In fact, upward of 10 percent of women are able to recover their fertility. Research shows that eliminating processed foods and eating a lot more plant-based foods can reduce your risk of menopause-related side effects including depression and stress. That’s where we started: Cleaning up Sandi’s diet; removing hot-flash-inducing sugar, caffeine, alcohol, and other food sensitivities; and adding in lots of anti-inflammatory, antioxidant-rich whole foods. Along with these strategies, Sandi visited a therapist who helped her work through the emotional changes early menopause can evoke. Together with my treatment, we created a protocol to help Sandi revive her libido, reach her healthy weight, and feel like her former confident, sexy self. This didn’t happen overnight. For Sandi, it took about three months to eliminate her uncomfortable symptoms. The emotional repercussions of early menopause took longer to resolve with her therapist, but she felt much more confident after our last consultation. (Big bonus: After nearly two years, Sandi got her period back!) Struggling with birth control side effects? Here’s your expert guide.
