Menopause

Every woman’s experience of menopause can be different. Some women say that their symptoms that they were experiencing in perimenopause worsened or some note that they improved at menopause. 

Symptoms that were noted in perimenopause may be present at varying degrees. Other factors that may affect how you experience menopause may include: current health state, weight (overweight or underweight), smoker, alcohol use, activity level, mental or emotional stress, life stability, economic status, along with others.

• Hot flashes are the most common. They involve a sudden wave of heat or warmth often accompanied by flushing of the skin, sweating, and increased heart rate or palpitations. They usually last 1-5 minutes and can be followed by a cold chill. They can occur numerous times per hour or day/night. 

• Night sweats are hot flashes that occur at night and can affect your quality and quantity of sleep. You may wake up and note that your bed sheets are soaked from sweat and may find it difficult to get comfortable due to the hot flash which is then often followed by a cold chill. 

• Vaginal atrophy, or vaginal dryness and thinning of the vaginal wall is caused by the drop in estrogen around menopause. It can cause pain with intercourse, irritation to urethra and burning when voiding, and soreness. 

Hormone levels do change throughout the menstrual cycle, so it is helpful to understand where you are in your cycle when you have serology hormone testing done. During perimenopause these numbers can fluctuate greatly, and you will find that some months, your estrogen dominance is very elevated compared to other times. Testing can help you understand what is happening with your ovarian function and hormone balance and can assist your nurse practitioner to complete your individual assessment thus providing support and direction when it comes to your unique hormone treatment plan. Comprehensive testing is also helpful to ensure there are no other underlying concerns that are contributing to your symptoms. 

Although the follicle- stimulating hormone (FSH) level is sometimes used to determine whether you are in menopause, it is not always reliable. According to evidence-based practice, a FSH blood level that is consistently elevated to 30 mlU/ml or higher, along with a history of no menses for a period of 1 year is generally accepted to be a confirmation that the woman is in menopause. 

However, a single FSH level can be misleading and throughout perimenopause can fluctuate greatly during the month and when comparing month to month. Medications, such as birth control pills also affects serum hormonal levels.

Initially, serum or blood tests are ordered to determine where you are currently. These tests are ordered by our nurse practitioner and are covered through your provincial health coverage. Specific tests will be repeated throughout your hormonal treatment plan depending on the medication that you are on. 

DUTCH, or DUTCH plus can also be very helpful in looking at hormone pathways and levels. These are available through Nature Doctors and can be ordered by your nurse practitioner or naturopathic doctor. The fee varies and is usually not covered by private insurance or your provincial health coverage. 

Saliva testing is not ordered through your nurse practitioner within Hormones and Health or Nature Doctors. If you do have saliva testing results, you can share them with your nurse practitioner but these will not be used to initiate, maintain or evaluate hormone replacement therapy.

All testing is individualized and is based on your medical and surgical history along with your current symptoms.

Hormone tests may include the following: FSH, LH, progesterone, estradiol, 17 hydroxyprogesterone, testosterone, DHEA, SHBG, FAI, prolactin, and cortisol. 

Further testing, depending on your symptoms may include: TSH, T4, T3, TSH receptor antibody, TPO antibodies, thyroglobulin, Vit B, iron studies, CBC, LFTs, lytes, lipid panel, FBG, HgbA1C, insulin.

Treatment is individualized and depends on your symptoms and lab results. However, treatment may include BHRT micronized progesterone, estradiol, and testosterone along with other supplements and medications. 

The medications may be in oral, sublingual, cream, or patch form. This is based on your comprehensive testing and assessment.

Supplements that may be useful in helping to manage your symptoms are:

• Vitamin B12, B5, B6 

• Vitamin D

• Zinc

• Selenium

• Magnesium

• Others may also be recommended depending on your current and past medical history and symptoms