Monday, October 8, 2018

Perimenopause & the Adrenal Connection

Last weekend I attended a seminar on understanding the rise and fall of hormones during perimenopause presented by Annette Kutz Schippel, DC. She practices nutrition and chiropractic in Illinois, specializing in women’s issues and pediatrics.

This is the third seminar I have taken with her. Her style is casual and easy going but she has a wealth of knowledge. This class completes my continuing education requirements for 2018 as a diplomate in nutrition. I have the choice of attending a couple of classes each year or presenting a paper for publication. Although I enjoy the challenge of writing, especially when it has to meet the requirements of peer review, I never seem to find the time.

I’ve attended several seminars on women’s health issues, particularly on menopause. However, this is the first that focused on perimenopause and, no pun intended, it did really fill in a gap.

As women enter perimenopause, hormone levels begin to fluctuate outside the normal ovulation cycle. This transition typically begins 2-3 years prior to menopause, but can start as much as 8-10 years before true menopause. By definition, menopause officially begins after menstruation has ceased for a full year.

During this transition women often experience heavier than normal bleeding, irregularity of the cycle, insomnia, depression, mood swings, weight gain, menstrual migraines, decreased fertility, decreased libido, bladder problems, fatigue, hot flashes, vaginal dryness, and more frequent illness.

Common treatment options are oral birth control, often prescribed to be taken continuously, progestin therapy, endometrial ablation surgery, bioidentical hormone treatment, partial or complete hysterectomy and/or increased use of anti-anxiety and anti-depressant medications.

Stress plays a large role in the severity of symptoms and typically the more severe the symptoms of perimenopause, the more severe her symptoms will be during menopause. This is because the adrenal glands, your organs that respond to stress, now have the additional burden of trying to make up for declining hormone production from the ovaries.

Supporting adrenal function is the first and most important step in treating perimenopause. Fortunately, nutritional supplementation, especially herbal preparations are very effective in restoring adrenal function.

Adaptogens provide the base of premenopausal support. Adaptogens are herbs that can rebuild the adrenals. They have all been proven to repair cellular DNA damage as well. The known Adaptogens are: Rhodiola, Schisandra, Eleuthero, Ashwaganda, Astagalus, Echinacea root, Gotu kola, Shatavari, and Korean ginseng. Maca may also be an adaptogen, but scientific studies are still lacking.

Which adaptogen(s) to use depends a lot on the symptoms of the patient. For example, Rhodiola is good for hot flashes while Eleuthero is better for someone that always feels cold and has frequent infections.

Often patients can be treated based on history and examination. However, with more difficult cases salivary testing of hormones can provide accurate assessment of DHEA, estradiol, estrone, estriol, progesterone, testosterone, FSH, LH. The ASI-Adrenal Stress Index tests for cortisol, DHEA, 17-OH progesterone, 2 insulin, salivary SigA, and gliadin AB.

Bottom Line:
Anyone suffering symptoms of perimenopause should have nutritional evaluation for supplemental support. In addition, improving the diet, exercising regularly and reducing stress must be instituted for supplementation to be effective.

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