Close this search box.
Close this search box.

A Woman’s Guide to Menopause

Naturally, women lose their estrogens around the age of 50.


Many may state that this is the natural way of the body. But why then, do so many women feel so badly when this happens? The answer is that estrogen is needed throughout the course of life to regain and sustain optimum health.


Hormones, like estrogen, are essential to every function of the body. From mood, to memory, to muscle, to metabolism, estrogens give women energy and the ability to build.


Estrogens build the skin, hair, heart, bone, muscle and every tissue in your body. When women go through menopause, the ability to grow new tissue is markedly reduced. The loss of muscle and bone, the loss of brain tissue, the loss of connective tissue in the skin, the loss of muscle in the heart and artery walls, are only a few of the systems impacted for the rest of a woman’s life when her estrogens decline.

The Symptoms of Menopause

Conventional wisdom is that hot flashes, which afflict up to 80 percent of middle-aged women, usually persist for just a few years. But hot flashes can continue for as long as 14 years and the earlier they begin the longer a woman is likely to suffer.


Among women who get hot flashes before they stopped menstruating, the hot flashes are likely to continue for years after menopause, longer than for women whose symptoms began only when their periods had stopped.


Women who started getting hot flashes when they were still having regular periods or were in early perimenopause experienced symptoms for a median of 11.8 years. About nine of those years occurred after menopause, nearly three times the median of 3.4 years for women whose hot flashes did not start until their periods stopped.


Hot flashes, which can seize women many times a day and night — slathering them in sweat, flushing their faces — are linked to drops in estrogens. Studies have found that women with hot flash symptoms also face increased risk of cardiovascular problems and bone loss.


The list of symptoms for women in menopause is extensive! In order to assist the reader in evaluating which hormone (or hormones) is causing the symptom, we provide a comprehensive list of symptoms and relate them to possible hormone deficiencies or excess.


Knowledgeable and trained physicians in treating women with menopause use this list to relate the symptoms to the hormone deficiency or excess.

Estrogen Deficiency
Hot flashes Night Sweats Sleep Disturbances
Vaginal Dryness/atrophy Dry Skin Headaches
Foggy thinking Memory lapses Heart palpitations
Heart palpitations Yeast infections Painful intercourse
Depression Low libido Bone Loss
Estrogen Excess
Water retention Heavy, irregular menses Breast swelling and tenderness
Fatigue Craving for sweets Weight gain
Fibrocystic breasts Mood swings Uterine fibroids
Low thyroid symptoms Nervousness/anxiety Irritability
Progesterone Deficiency
Many of the symptoms of estrogen excess including: Swollen breasts Headaches
Low libido Anxiety Mood swings
Irregular menses Depression Cramping
PMS Infertility Fuzzy thinking
Acne Joint pain Weight gain
Progesterone Deficiency
Somnolence Gastrointestinal bloating Mild depression
Breast swelling Candida exacerbations Exacerbated symptoms of estrogen deficiency
Testosterone Deficiency
Fatigue, prolonged Mental fuzziness Memory problems
Depression Decreased libido Blunted motivation
Muscle weakness Diminished feeling of well being Heart palpitations
Thinning skin Bone loss Vaginal dryness
Incontinence General aches/pains Fibromyalgia
Testosterone Excess
Acne Male-patten hair growth Deepening of voice
Clitoral enlargement Irritability/moodiness Insomnia
Loss of scalp hair
Low cortisol
Fatigue Allergies Cravings for sweets
Irritability Chemical sensitivities Symptoms of hypothyroidism
Symptoms of low progresterone
High cortisol
Same symptoms as low cortisol, including: Bone loss Anxiety
Sleep disturbances Low libido Hair loss
Anxiety Elevated triglycerides
Low Thyroid Function
Fatigue (especially evening) Low stamina Cold extremeties
Low body temperature Dry skin Intolerance to cold
General aches and pains Weight gain Depression
Anxiety Scalp hair loss Swollen, puffy eyes
Brittle nails Decreased swelling Low pulse rate/blood pressue
Poor concentration Memory lapses High cholesterol
Heart palpitations Infertility Constipation

Weight Gain during Menopause

As women approach menopause they endure many symptoms, but one that proves the most difficult for many women to accept is menopausal weight gain.


Not only can a few extra pounds (or maybe more) ravage a woman’s self-esteem and self-image, but weight gain can usher in a host of health concerns that put a woman at risk of developing life-threatening conditions. We know, at Forum Health, we see it every day.


About 90% of menopausal women experience some amount of weight gain. As many women can attest, it’s not just about what they are eating and how much they are exercising, as often they are doing both very well.


On average, women gain between 15 and 20 pounds between the ages of 45 and 55, the stage in life when menopause typically occurs. This extra weight generally does not evenly distribute itself throughout a woman’s body. The weight tends instead to accumulate around the abdomen, and women often notice the shape of their bodies slowly lose their hour-glass figure and begin to take on a rounded shape.


Frustrated as women may be at the knowledge that it is their hormone imbalance causing the weight gain, they often find little relief from their frustrations when seeing their doctor. Too often told “It’s part of getting older” and “It’s a natural part of menopause,” women seek out alternative advice from practitioners like those at Forum Health.


Women who gain in excess of 20 pounds after menopause increase their breast cancer risk by nearly 20%, but those who lose 20 pounds after menopause reduce their breast cancer risk by as much as 23%.

Hormonal Causes of Weight Gain

As years progress the metabolism slows, setting the physiological stage for weight gain. Although age itself can lead to plumped midsections, as a woman’s hormones fluctuate prior to menopause and preparing for a permanently reduced hormonal level, they are likely to experience weight gain.


A drop in estrogen and progesterone can increase a woman’s appetite and cause her to eat up to 67% more, according to one study. An increase in appetite coupled with a slower metabolism with the onset of menopause can cause weight gain in women. This could, perhaps, account for the 12% jump in the number of women who are overweight in midlife compared to women in their 20’s and 30’s.


A woman’s hormones have complex functions in her body, including weight control. Here’s a list of the different hormones that can affect weight gain and how:


As a woman’s ovaries produce less estrogen, her body attempts to find the hormone in places other than the ovaries. Fat cells can produce estrogen, so her body works harder to convert calories into fat to increase estrogen levels. Unfortunately, fat cells don’t burn calories the way muscle cells do, which causes weight gain.


Water retention is often linked to menopause because water weight and bloating decreases progesterone levels. Though this doesn’t actually result in weight gain, clothes can feel a bit tighter and a woman may feel as though she’s heavier.


Testosterone helps a woman’s body create lean muscle mass out of the calories consumed. Muscle cells burn more calories than fat cells do, increasing metabolic rate. As testosterone levels drop, fewer calories are transformed into lean muscle mass, thus a woman’s metabolism winds down.


The amount of this hormone increases at the onset of menopause. It’s responsible for sending new weight to the mid-section instead of to the hips, which many women are accustomed to. Some women even have a nickname for the menopause years based on the mid-section weight gain: “the middle-age spread”.

Insulin Resistance

Insulin resistance can occur during the menopausal years. This is when a woman’s body mistakenly turns every calorie taken in into fat. Over time, processed and refined foods may make a woman’s body resistant to insulin produced in the blood stream.

Low Thyroid

Women with an underactive thyroid often experience weight gain because their metabolic rate slows down as a result of the condition. In some cases, hyperthyroidism can also cause weight gain, but that is rare. Thyroid hormones essentially regulate calorie consumption in the body. With an underactive thyroid, fewer calories are burned and converted into energy. Instead they are stored in the body.

Weight gain does not have to be an inevitable part of aging and menopause. Instead, it is possible to identify common reasons for weight gain during this period, so that the issue can be addressed.

High Cortisol

Women are under a great deal more stress in this era than ever before. Women are often working as a man while often being a mother, best-friend, girl-friend or spouse. Work, children, aging parents, bills all contribute to the frustration and stress of life. We are no longer faced with only mental stress but also increased physical stress as the hours we sleep decrease, exercise may fall behind, and increasingly toxic world we live in continues to expand. Cortisol, the stress hormone, is often very high in women, much higher than we saw even a decade before. Cortisol causes weight gain, mostly in the belly, which with the other hormone imbalances makes it almost impossible to lose the weight.

Emotional Changes of Menopause

At around age 50, the ovaries stop producing estrogens. The ovaries have produced the greatest share of the body’s estrogens for decades, and when they quit, the blood levels of estrogens drop dramatically.


Many women go through this change feeling fine, both physically and psychologically. Nonetheless, some women are bothered by symptoms, including hot flashes, depression, irritability, anxiety, and other problems.


Hormone shifts can affect moods. It can be disturbing to find yourself feeling uncharacteristically nervous or depressed or having memory lapses. Sometimes these feelings can even strain your relationships with others. It helps to know that the psychological effects of menopause are temporary. In all likelihood, you’ll soon get back on an even keel. Here are the most common psychological accompaniments of menopause.


Although the commonly known symptoms of menopause, including hot flashes and night sweats, eventually disappear, the symptoms of anxiety, depression and poor memory may go on indefinitely.


Women who have never had a problem with anxiety before may become more self-conscious and worried about minor events. In some cases, panic attacks occur. Mental health professionals have a variety of effective treatments. Many people feel much better just knowing what the condition is. The most important piece of advice is not to let anxiety restrict your activities. When anxiety or panic disorders cause people to avoid stressful situations, the result can be an ever-tightening leash that keeps them from enjoying life. Anxiety can lead to avoidance of many aspects of normal life. Prompt treatment prevents this.

Depression and Irritability

Depression can be a problem for menopausal women. Irritability is also common. When considering treatment for depression, irritability, or anxiety, it is important to explore the full range of available options. The first step is to get your diet in order and to get regular exercise to help stabilize hormone shifts and reduce physical symptoms that can aggravate mood problems. Psychotherapy can be very useful, and new short-term techniques have demonstrated their effectiveness at considerably less investment than is demanded by traditional therapies. New antidepressants and anti-anxiety drugs have fewer side effects than older medications.

Poor Memory and Concentration

Some women find that menopause brings occasional memory lapses, often related to reduced ability to concentrate. This can be upsetting and annoying. Forgetting words which are just on “the tip of the tongue” is a frequent complaint. Being disorganized and unable to multi-task can negatively affect your work performance.


Hormone Testing

Hormone balance is essential to good health for women of all ages. Unfortunately, the accuracy of the tests used to determine hormone levels varies widely.


If a woman is not taking any hormones, then any method of measuring their levels can be used. However, if a woman is on topical or vaginal creams, then only salivary levels can be utilized. Not using saliva testing on women on topical or vaginal creams would lead the unknowing practitioner to overdose the amount of hormones given to a woman.


This is because topical hormones (in creams or gels) are absorbed through the lymphatic system and delivered directly to the tissues, by-passing the blood completely.


If a woman is on a patch of estradiol, receiving pellet therapy (estradiol and testosterone) or taking the hormones orally, then saliva, urine metabolites or blood may be used.


Saliva Testing

Saliva testing has been used in clinical research, including studies conducted at the National Institutes of Health (NIH) for more than 30 years. Saliva testing has been available to physicians for over a decade, and Medicare and many insurance companies provide reimbursement. Over years of clinical practice, it has been shown that saliva testing is the most accurate measurement of the body’s availability of the hormones Cortisol, DHEA, Estrogen, Progesterone, and Testosterone. Saliva testing is much more specific and correctly identifies the level of hormones at the cellular level, in contrast to a serum (blood) test, which measures the level of hormones circulating in the bloodstream.


Saliva testing is not helpful, however, to monitor women who are taking hormones in a sublingual (drops or spray) or transmucosal (lozenge or troche) format. These forms of hormone delivery concentrate the hormones in the salivary glands and the resulting saliva levels are too high to be useful.


Serum or Blood Testing

Most serum tests define the normal range of hormones very broadly, which is a distinct disadvantage to their use. After a woman’s blood has been drawn, a portion of the blood sample (the serum) is used to measure hormone levels. Most serum testing measures the level of “free” hormone (the hormone that can easily enter the cell), the level of the “total” hormone (the hormone attached to substances that carry hormones in the bloodstream), or a calculated combination of both free and total levels of hormone. It is not an accurate reflection of the bioavailable hormone (the amount of hormone that is active in organs and tissues).In addition, the results of the serum testing are often inconsistent, especially if the hormone value indicated is in the low-normal range. Serum testing is less helpful in monitoring women using transdermal (patch or cream) forms of hormones, as the hormone is bound to the red blood cell surface and does not register in the serum in very high amounts.


Many women whose serum test results are normal cannot understand why they continue to experience the symptoms of hormone imbalance. (Saliva testing, however, provides a more exact range of normal results.)


Urinary Metabolites

Although not useful when women are on topical or vaginal applications of hormones, urinary metabolites offer the unique ability to measure the metabolites of all the hormones. The importance of knowing the metabolites is that although the natural hormones are not implicated in the development of cancer, the estrogen metabolite in the quinone form has been linked to cancer development. Understanding if the patient is metabolizing down the wrong pathway is can lead the practitioner to utilize nutritional and supplemental support to adjust the method by which the patient metabolizes their hormones. Metabolism of hormones is the first step in eliminating the by-products from a woman’s system.


Differing from saliva or blood measurement which measures the level of the hormones, urine testing measures the amount of hormones excreted in the urine. Saliva and blood measure the level at that time of day, whereas urine metabolites measure the amounts of hormones and metabolites excreted during a 24 hour period.


Not Testing Hormone Levels

Some physicians do not measure hormone levels because they are not knowledgeable in the utilization of the differing testing measures. They prescribe hormones as creams, get relief of symptoms, but then cannot explain why the blood levels are still low.


This is the major reason why some physicians do not believe topical and transvaginal creams work, simply because they see no change in the blood levels.

Safe and Effective Hormone Therapy

Much confusion exists in the general public as well as mainstream medicine that hormone replacement for women is dangerous, and should be avoided, or at least used for only a very short time.


Many women are rightfully concerned about the link between the use of estrogen and cancer. This is an area of intense research and debate. To date, studies such as the Women’s’ Health Initiative have shown us the dangers of using non-bioidentical hormones such as Premarin and Provera (a synthetic hormone). However, to date, there is no study that links bioidentical hormone replacement, especially when used in the context of balancing all of one’s hormones, to this risk of increased cancer. Think about it, the time in our lives when we were the healthiest and cancer-free were when we were in our late 20s, the exact same time when our hormones were their strongest!


Some may try to make you believe that an herb or a dietary supplement like soy can replace what a woman is missing. Although a few of these products may relieve some of the symptoms of menopause, they provide no long-term protection against heart disease, osteoporosis, or Alzheimer’s disease. We believe in listening to a woman’s symptoms, testing a woman’s hormonal levels, and then prescribing exactly what she is missing, her hormones!


Schedule your appointment with Forum Health today!