It’s widely believed that estrogen declines in menopause, causing the symptoms that many women experience. But the truth is far more nuanced. Estrogen levels in the blood may decline in menopause while it becomes dominant in the tissues. This increased and prolonged exposure to estrogen causes many of the issues women experience such as menopause symptoms, glucose intolerance, insulin resistance, autoimmunity, inflammation, and heightened risk of cancer.
Researchers have found that the failure to produce progesterone corresponds with the onset of menopause symptoms: (bone loss, depression, insomnia, and hot flashes) while estrogen is still present at normal levels in the tissues. The failure of progesterone allows cortisol to dominate, causing many of the “menopause” symptoms, and the discrepancy between the two hormones results in a functional excess of estrogen. Further, estrogen increases the production of cortisol, causing a negative feedback loop of stress.
Estrogen dominance in the tissues impacts overall hormone balance! I like to see the ratio between estrogen and progesterone in the 200-500 range. When levels are below 100 it is considered a state of relative estrogen dominance, such as is observed in almost every ER+ breast cancer patient. Biomarkers from a study measuring serum and tissue levels of estrogen and progesterone showed that, in the menopausal women studied, the progesterone to estrogen ratio was far below 100 in both the blood and tissues.
What causes menopausal progesterone deficiency? In menopause, a complex of stress-related causes interfere with progesterone synthesis. Free-radicals, prolactin, adrenocorticotropic hormone, estrogen, cortisol, and a deficiency of thyroid, vitamin A, and LDL cholesterol can all prevent the synthesis of progesterone.
Placebo-controlled studies have found that not everyone with menopausal symptoms who receives estrogen actually benefits from it when alternated with a placebo. While it is possible that those who feel better on estrogen therapy may have an estrogen deficiency, estrogen is far from the only hormone that plays a role in the alleviation of symptoms, and some other factor could cause the improvement. For example, elevated estrogen can cause the thyroid to release more hormones in response, making the symptomatic patient feel much better.
So what’s a better approach?
The All Method is a strategy to support the body through menopause, prioritizing safer and more effective therapeutic tools before using estrogen.
- Progesterone. Because of the massive decline in progesterone that happens in menopause, supplementing progesterone is the first line of defense against unwanted symptoms. It helps to balance estrogen, stop night sweats, improve sleep, and lower stress.
- DHEA. An important youth hormone, levels of DHEA also rapidly decline with age. While it should be used in low doses, it can significantly lower the cortisol that increases during the menopausal years.
- Pregnenolone. This hormone is the precursor to almost every steroid hormone, and can help replace what is lost in menopause, effectively filling in the gaps.
- Natural Desiccated Thyroid. Levels of thyroid hormone also will often decrease with age, especially in women. Supplementing natural desiccated thyroid can help with fatigue, weight gain, and brain fog.
- Estrogen-only if still needed. Some women find that they still need a small amount of estrogen to alleviate symptoms. Using it should be done with caution, and it should never be taken orally. Applying a small amount of cream should be all that’s needed.
- Don’t forget to address the basics! Sleep, sunlight, movement, and nutrition.