From puberty to the monthly mood swings thereafter to pregnancy, hormones have a way of making their presence known. But it’s perhaps not until perimenopause (the period before menopause when physical symptoms start) that women fully recognize the connection between hormones and our well-being. (Night sweats, anyone…) To find out how to prepare for what my mom’s generation called “the change,” or better manage it if we’re already in it, I spoke with naturopath Dr. Stacy Cootauco about hormones and menopause.
Dr. Cootauco is well-versed on the topic, with a patient base that’s about 70 per cent women aged 40 and over. She’s a graduate of the Canadian College of Naturopathic Medicine, and practices in Toronto at both the H.O.P.E. Clinic of Integrative Medicine (working with a medical doctor trained in complementary and functional medicine) and at the Chopra Yoga Center. Dr. Cootauco has also studied acupuncture in Japan, Ayurvedic and homeopathic medicine in India, and functional medicine in Baltimore.
It’s a path she was seemingly destined for Dr. Cootauco recounted with a laugh that she was doing presentations on Chinese medicine even in high school. But it wasn’t until working at a hospital while completing her undergrad in physiology at the University of Toronto and seeing patients return with the same issues that she decided to pursue a more holistic kind of medicine.
While enthused about discussing hormones and menopause, Dr. Cootauco emphasized the need to see your own health-care professional about any specific symptoms.
Beauty in the Middle: Speaking of hormones and menopause, if a woman is still menstruating, but having symptoms such as night sweats or mood swings, how can she know for sure if she’s in periomenopause or menopause?
Dr. Cootauco: The main thing that comes up is her periods become irregular or more erratic. Or they’ve changed in terms of becoming heavier. Just before menopause, estrogen goes up relative to progesterone, and since estrogen is a tissue-building hormone, the periods become heavier because the endometrium is thicker.
But if she goes to her medical doctor and just wants to know “Am I in periomenopause or menopause?” she can ask for a standard blood-work test, which will look at the main female hormones. Say that test is normal, the doctor may do other standard tests to rule out other causes. There could be issues with thyroid or diabetes, for example, that may have overlapping symptoms.
If a woman feels her symptoms are affecting daily living and standard tests don’t identify a cause, she can get other tests with naturopaths. Some naturopaths will do saliva hormone tests which sometimes catch things blood tests don’t. There are also urine tests, which give more information in terms of what hormones she is producing and how she is processing them. Sometimes the by-products are stronger than the parent hormone. So it can cause more issues to have a liver not processing hormones properly. And a urine test can reveal this. And if someone wants to assess breast-cancer risk, she can do it through a urine test.
When a patient comes to you with menopausal symptoms, are there any stock things you recommend?
Women [often] think their only option is hormone therapy, when it’s not. If you see a naturopath or a holistic practitioner, you can find other ways to help lessen symptoms. Usually a naturopathic intake [an initial appointment] with a patient can be anywhere from an hour and a half to two hours. Whether it’s physical, mental or emotional concerns, or past history, a naturopath looks at all possible angles. Treatment is then individually targeted because there are so many different nutrients and herbs you can use for menopause.
What are some of the lifestyle practices you’ve seen help menopausal symptoms?
I’ve noticed that women who come in who are exercising regularly, more or less, and eating well before they hit perimenopause are the ones who do better usually.
And, on the negative side, what are some lifestyle habits that can worsen symptoms?
Alcohol can raise estrogen if you have more than four servings a week. Caffeine can also alter the way you process estrogen.
Why is elevated estrogen an issue?
People usually think when they hit menopause, lower estrogen is the problem. But it depends on the person. So this is another reason why it’s good to get tested. You could be a medical doctor who hands out synthetic or bio-identical hormones, but if a patient already has elevated estrogen and you give her more; it’s going to make her worse.
Basically estrogen is a big thing because there are so many ways of raising it, even in menopause. You have the plastics, the phthalates, the parabens all the chemicals in the environment that act like estrogen. Fat makes estrogen, so being overweight can cause excess levels of it. And poor gastrointestinal health can cause your body to recycle estrogen. You can reabsorb it from the intestinal tract. This is a problem because the first hormone to lessen in perimenopause is progesterone, not estrogen. So you wind up with a significant imbalance between the two.
Are there natural ways to raise progesterone levels?
The main thing I’d say from a naturopathic or herbal approach is chaste tree (Vitex agnus). Chaste tree works upon the brain to help your body make progesterone. But you often need to combine it with other herbs to make it more effective. The choice of herbs depends on a woman’s overall symptoms. And if a woman is opting for an herbal route, and especially with chaste tree, I generally see the most benefit after three months of use, on average.
Any other herbs you often work with for menopause?
Black cohosh is a go-to herb. Sometimes just doing that or finding a formula that has a combination of black cohosh and red clover is beneficial. And if there’s depression, a lot of people will benefit from St. John’s wort. If there are hot flashes and night sweats, sage can be good. But if they have energy problems or stress, then you look at herbs that help the adrenal glands. And then you always need a nutrient base. A multivitamin, fish oil, vitamin C, B vitamins and vitamin D. That’s my base!
Any other nutritional guidelines for menopausal patients?
Any time you’re addressing the hormones, this is really big, you have to address the liver, gastrointestinal tract and, to an extent, kidney health. Because this is the way you process and eliminate hormones. So it’s a very holistic plan. For example, the liver detoxifies estrogen, which is then released into the gut for excretion. If a person has an overgrowth of bacteria, it can cause reabsorption of estrogen. As a result, you want to clean up the gut and put in good bacteria.
How do you do that?
Basically limiting all the processed foods and sugars (they have a huge effect on estrogen). And then you have to consider food intolerances. So whether it’s wheat or all gluten grains or dairy or eggs, you have to remove everything that’s offending the intestinal tract. Then you put in good bacteria through fermented foods and supplementation. Food intolerances can be determined though an elimination diet or food-allergy tests.
Are there other helpful foods you recommend for this life stage?
Flax seeds and soy help your body process hormones better. There were some early studies that weren’t designed well that showed soy caused breast cancer. But most well-designed studies now point to the benefit and protection [soy offers]. And if somebody were on two to four tablespoons of ground flax seeds daily for a month, it would change how she metabolizes estrogen. And this can be seen in urine tests.
If you’re interested in seeing a naturopathic doctor for menopausal or other issues, Dr. Cootauco emphasized it’s less a quick-fix approach than conventional medicine. “You go to a medical doctor when you feel sick, but you go to a naturopath when you want to stay well and not be sick,” said Dr. Cootauco. “Naturopathic medicine is more a process of lifestyle change.”
Dr. Cootauco was a wealth of information on hormones and menopause, but she also had much to say about other midlife issues. Stay tuned for a follow-up post in which she explains why women get the dreaded midlife “muffin top,” what anti-aging skin-care ingredients to look for and more.