What Does “Balance Your Hormones” Even Mean?

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Hormonal Health: Is It Really A Balancing Act?

Have you ever wondered what “balancing your hormones” actually means?

The popular view is that men’s hormones look like this:

Testosterone (less) ⟷ Testosterone (more)

…And that women’s hormones look more like this:

♀︎ Estrogen ↭ Progesterone ⤵︎

⇣⤷ FSH ⤦ ↴ ☾ ⤹⤷ Luteinizing Hormone ⤦

DHEA ↪︎ Gonadotrophin ⤾

↪︎ Testosterone? ⥅⛢

Clear as mud, right?

But, don’t worry, Supplements McHerbal Inc will sell you something guaranteed to balance your hormones!

How can a supplement (or dietary adjustment) “balance” all that hotly dynamic chaos, and make everything “balanced”?

The truth is, “balanced” in such a nebulous term, and this is why you will not hear endocrinologists using it. It’s used in advertising to mean “in good order”, and “not causing problems”, and “healthy”.

In reality, our hormone levels depend on everything from our diet to our age to our anatomy to our mood to the time of the day to the phase of the moon.

Not that the moon has an influence on our physiology at all—that’s a myth—but you know, 28 day cycle and all. And, yes, half the hormones affect the levels of the others, either directly or indirectly.

Trying to “balance” them would be quite a game of whack-a-mole, and not something that a “cure-all” single “hormone-balancing” supplement could do.

So why aren’t we running this piece on Friday, for our “mythbusting” section? Well, we could have, but the more useful information is yet to come and will take up more of today’s newsletter than the myth-busting!

What, then, can we do to untangle the confusion of these hormones?

Well first, let’s understand what they do, in the most simple terms possible:

  • Estrogen—the most general feminizing hormone from puberty onwards, busiest in the beginning of the menstrual cycle, and starts getting things ready for ovulation.
  • Progesteronesecondary feminizing hormone, fluffs the pillows for the oncoming fertilized egg to be implanted, increases sex drive, and adjusts metabolism accordingly. Busiest in the second half of the menstrual cycle.
  • Testosterone—is also present, contributes to sex drive, is often higher in individuals with PCOS. If menopause is untreated, testosterone will also rise, because there will be less estrogen
    • (testosterone and estrogen “antagonize” each other, which is the colorfully scientific way of saying they work against each other)
    • DHEA—Dehydroepiandrosterone, supports production of testosterone (and estrogen!). Sounds self-balancing, but in practice, too much DHEA can thus cause elevated testosterone levels, and thus hirsutism.
  • Gonadotrophin—or more specifically human chorionic gonadotrophin, HcG, is “the pregnancy hormone“, present only during pregnancy, and has specific duties relating to such. This is what’s detected in (most) pregnancy test kits.
  • FSH—follicle stimulating hormone, is critical to ovulation, and is thus essential to female fertility. On the other hand, when the ovaries stop working, FSH levels will rise in a vain attempt to encourage the ovulation that isn’t going to happen anymore.
  • Luteinizing hormone—says “go” to the new egg and sends it on its merry way to go get fertilized. This is what’s detected by ovulation prediction kits.

Sooooooo…

What, for most women, most often is meant by a “hormonal imbalance” is:

  • Low levels of E and/or P
  • High levels of DHEA and/or T
  • Low or High levels of FSH

In the case of low levels of E and/or P, the most reliable way to increase these is, drumroll please… To take E and/or P. That’s it, that’s the magic bullet.

Bonus Tip: take your E in the morning (this is when your body will normally make more and use more) take your P in the evening (it won’t make you sleepy, but it will improve your sleep quality when you do sleep)

In the case of high levels of DHEA and/or T, then that’s a bit more complex:

  • Taking E will antagonize (counteract) the unwanted T.
  • Taking T-blockers (such as spironolactone or bicalutamide) will do what it says on the tin, and block T from doing the jobs it’s trying to do, but the side-effects are considered sufficient to not prescribe them to most people.
  • Taking spearmint or saw palmetto will lower testosterone’s effects
    • Scientists aren’t sure how or why spearmint works for this
    • Saw palmetto blocks testosterone’s conversion into a more potent form, DHT, and so “detoothes” it a bit. It works similarly to drugs such as finasteride, often prescribed for androgenic alopecia, called “male pattern baldness”, but it affects plenty of women too.

In the case of low levels of FSH, eating leafy greens will help.

In the case of high levels of FSH, see a doctor. HRT (Hormone Replacement Therapy) may help. If you’re not of menopausal age, it could be a sign something else is amiss, so it could be worth getting that checked out too.

What can I eat to boost my estrogen levels naturally?

A common question. The simple answer is:

  • Flaxseeds and soy contain plant estrogens that the body can’t actually use as such (too incompatible). They’ve lots of high-quality nutrients though, and the polyphenols and isoflavones can help with some of the same jobs when it comes to sexual health.
  • Fruit, especially peaches, apricots, blueberries, and strawberries, contain a lot of lignans and also won’t increase your E levels as such, but will support the same functions and reduce your breast cancer risk.
  • Nuts, especially almonds (yay!), cashews, and pistachios, contain plant estrogens that again can’t be used as bioidentical estrogen (like you’d get from your ovaries or the pharmacy) but do support heart health.
  • Leafy greens and cruciferous vegetables support a lot of bodily functions including good hormonal health generally, in ways that are beyond the scope of this article, but in short: do eat your greens!

Note: because none of these plant-estrogens or otherwise estrogenic nutrients can actually do the job of estradiol (the main form of estrogen in your body), this is why they’re still perfectly healthy for men to eat too, and—contrary to popular “soy boy” social myths—won’t have any feminizing effects whatsoever.

On the contrary, most of the same foods support good testosterone-related health in men.

The bottom line:

  • Our hormones are very special, and cannot be replaced with any amount of herbs or foods.
  • We can support our body’s natural hormonal functions with good diet, though.
  • Our hormones naturally fluctuate, and are broadly self-correcting.
  • If something gets seriously out of whack, you need an endocrinologist, not a homeopath or even a dietician.

In case you missed it…

We gave a more general overview of supporting hormonal health (including some hormones that aren’t sex hormones but are really important too), back in February.

Check it out here: Healthy Hormones And How To Hack Them

Want to read more?

Anthea Levi, RD, takes much the same view:

❝For some ‘hormone-balancing’ products, the greatest risk might simply be lost dollars. Others could come at a higher cost.❞

Read: Are Hormone-Balancing Products a Scam?

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  • Lemon Balm For Stressful Times And More

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    Balm For The Mind: In More Ways Than One!

    Lemon balm(Melissa officinalis) is quite unrelated to lemons, and is actually a closer relative to mint. It does have a lemony fragrance, though!

    You’ll find it in a lot of relaxing/sleepy preparations, so…

    What does the science say?

    Relaxation

    Lemon balm has indeed been found to be a potent anti-stress herb. Laboratories that need to test anything to do with stress generally create that stress in one of two main ways:

    • If it’s not humans: a forced swimming test that’s a lot like waterboarding
    • If it is humans: cognitive tests completed under time-pressure while multitasking

    Consequently, studies that have set out to examine lemon balm’s anti-stress potential in humans, have often ended up also highlighting its potential as a cognitive enhancer, like this one in which…

    ❝Both active lemon balm treatments were generally associated with improvements in mood and/or cognitive performance❞

    ~ Dr. Anastasia Ossoukhova et al.

    Read in full: Anti-Stress Effects of Lemon Balm-Containing Foods

    And this one, which found…

    ❝The results showed that the 600-mg dose of Melissa ameliorated the negative mood effects of the DISS, with significantly increased self-ratings of calmness and reduced self-ratings of alertness.

    In addition, a significant increase in the speed of mathematical processing, with no reduction in accuracy, was observed after ingestion of the 300-mg dose.❞

    ~ Dr. Wendy Little et al.

    The appropriately named “DISS” is the Defined Intensity Stress Simulation we talked about.

    Read more: Attenuation of laboratory-induced stress in humans after acute administration of Melissa officinalis (Lemon Balm)

    Sleep

    There’s a lot less research for lemon balm’s properties in this regard than for stress/anxiety, and it’s probably because sleep studies are much more expensive than stress studies.

    It’s not for a lack of popular academic interest—for example, typing “Melissa officinalis” into PubMed (the vast library of studies we often cite from) autosuggests “Melissa officinalis sleep”. But alas, autosuggestions do not Randomized Controlled Trials make.

    There are some, but they’re often small, old, and combined with other things, like this one:

    A combination of valerian and lemon balm is effective in the treatment of restlessness and dyssomnia in children

    This is interesting, because generally speaking there is little to no evidence that valerian actually helps sleep, so if this mixture worked, we might reasonably assume it was because of the lemon balm—but there’s an outside chance it could be that it only works in the presence of valerian (unlikely, but in science we must consider all possibilities).

    Beyond that, we just have meta-reviews to work from, like this one that noted:

    ❝M. officinalis contains several phytochemicals such as phenolic acids, flavonoids, terpenoids, and many others at the basis of its pharmacological activities. Indeed, the plant can have antioxidant, anti-inflammatory, antispasmodic, antimicrobial, neuroprotective, nephroprotective, antinociceptive effects.

    Given its consolidated use, M. officinalis has also been experimented with clinical settings, demonstrating interesting properties against different human diseases, such as anxiety, sleeping difficulties, palpitation, hypertension, depression, dementia, infantile colic, bruxism, metabolic problems, Alzheimer’s disease, and sexual disorders. ❞

    ~ Dr. Cristina Quispe et al.

    You see why we don’t try to cover everything here, by the way!

    But if you want to read this one in full, you can, at:

    An Updated Review on The Properties of Melissa officinalis L.: Not Exclusively Anti-anxiety

    Is it safe?

    Lemon balm is generally recognized as safe, and/but please check with your doctor/pharmacist in case of any contraindications due to medicines you may be on or conditions you may have.

    Want to try some?

    We don’t sell it, but here for your convenience is an example product on Amazon

    Want to know your other options?

    You might like our previous main features:

    What Teas To Drink Before Bed (By Science!)

    and

    Safe Effective Sleep Aids For Seniors

    Enjoy!

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  • Why You Should Diversify Your Nuts!

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    Time to go nuts for nuts!

    Nuts, in popular perception, range from “basically the healthiest food anyone can eat” to “basically high calorie salty snacks”. And, they can be either!

    Some notes, then:

    • Raw is generally better that not
    • Dry roasted is generally better than the kind with added oils
    • Added salt is neither necessary nor good

    Quick tip: if “roasted salted” are the cheapest or most convenient to buy, you can at least mitigate that by soaking them in warm water for 5 minutes, before rinsing and (if you don’t want wet nuts) drying.

    You may be wondering: who does want wet nuts? And the answer is, if for example you’re making a delicious cashew and chickpea balti, the fact you didn’t dry them before throwing them in won’t make a difference.

    Now, let’s do a quick run-down; we don’t usually do “listicles” but it seemed a good format here, so we’ve picked a top 5 for nutritional potency:

    Almonds

    We may have a bias. We accept it. But almonds are also one of the healthiest nuts around, and generally considered by most popular metrics the healthiest.

    Not only are they high in protein, healthy fat, fiber, vitamins, and minerals, but they’re even a natural prebiotic that increases the populations of healthy gut bacteria, while simultaneously keeping down the populations of gut pathogens—what more can we ask of a nut?

    Read more: Prebiotic effects of almonds and almond skins on intestinal microbiota in healthy adult humans

    Pistachios

    Not only are these super tasty and fun to eat (and mindful eating is all but guaranteed, as shelling them by hand slows us down and makes us more likely to eat them one at a time rather than by the handful), but also they contain lots of nutrients and are lower in calories than most nuts, so they’re a great option for anyone who’d like to eat more nuts but is doing a calorie-controlled diet and doesn’t want to have half a day’s calories in a tiny dish of nuts.

    See: Effects of Pistachio Consumption in a Behavioral Weight Loss Intervention on Weight Change, Cardiometabolic Factors, and Dietary Intake

    Walnuts

    Popularly associated with brain health (perhaps easy to remember because of their appearance), they really are good for the brain:

    Check it out: Beneficial Effects of Walnuts on Cognition and Brain Health

    Cashews

    A personal favorite of this writer for their versatility in cooking, food prep, or just as a snack, they also do wonders for metabolic health:

    Learn more: The Effect of Cashew Nut on Cardiovascular Risk Factors and Blood Pressure: A Systematic Review and Meta-analysis

    Brazil nuts

    The most exciting thing about these nuts is that they’re an incredibly potent source of selenium, which is important not just for hair/skin/nails as popularly marketed, but also for thyroid hormone production and DNA synthesis.

    But don’t eat too many, because selenium is definitely one of those “you can have too much of a good thing” nutrients, and selenium poisoning can make your hair (however beautiful and shiny it got because of the selenium) fall out if you take too much.

    Know the numbers: Brazil nuts and selenium—health benefits and risks

    Bottom line on nuts:

    • Nuts are a great and healthful part of almost anyone’s diet
      • Obviously, if you have a nut allergy, then we’re sorry; this one won’t have helped you so much
    • Almonds are one of the most healthful nuts out there
    • Brazil nuts are incredibly potent, to the point where moderation is recommended
    • A handful of mixed nuts per day is a very respectable option—when it comes to food and health, diversity is almost always good!

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  • The Sweet Truth About Diabetes

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    There’s A Lot Of Confusion About Diabetes!

    For those readers who are not diabetic, nor have a loved one who is diabetic, nor any other pressing reason to know these things, first a quick 101 rundown of some things to understand the rest of today’s main feature:

    • Blood sugar levels: how much sugar is in the blood, measured in mg/dL or mmol/L
    • Hyperglycemia or “hyper” for short: too much sugar in the blood
    • Hypoglycemia or “hypo” for short: too little sugar in the blood
    • Insulin: a hormone that acts as a gatekeeper to allow sugar to pass, or not pass, into various parts of the body
    • Type 1 diabetes (sometimes capitalized, and/or abbreviated to “T1D”) is an autoimmune disorder that prevents the pancreas from being able to supply the body with insulin. This means that taking insulin consistently is necessary for life.
    • Type 2 diabetes is a matter of insulin resistance. The pancreas produces plenty of insulin, but the body has become desensitized to it, so it doesn’t work properly. Taking extra insulin may sometimes be necessary, but for many people, it can be controlled by means of a careful diet and other lifestyle factors.

    With that in mind, on to some very popular myths…

    Diabetes is caused by having too much sugar

    While sugar is not exactly a health food, it’s not the villain of this story either.

    • Type 1 diabetes has a genetic basis, triggered by epigenetic factors unrelated to sugar.
    • Type 2 diabetes comes from a cluster of risk factors which, together, can cause a person to go through pre-diabetes and acquire type 2 diabetes.
      • Those risk factors include:
        • A genetic predisposition
        • A large waist circumference
          • (this is more relevant than BMI or body fat percentage)
        • High blood pressure
        • A sedentary lifestyle
        • Age (the risk starts rising at 35, rises sharply at 45, and continues upwards with increasing age)

    Read more: Risk Factors for Type 2 Diabetes

    Diabetics can’t have sugar

    While it’s true that diabetics must be careful about sugar (and carbs in general), it’s not to say that they can’t have them… just: be mindful and intentional about it.

    • Type 1 diabetics will need to carb-count in order to take the appropriate insulin bolus. Otherwise, too little insulin will result in hyperglycemia, or too much insulin will result in hypoglycemia.
    • Type 2 diabetics will often be able to manage their blood sugar levels with diet alone, and slow-release carbs will make this easier.

    In either case, having quick release sugars will increase blood sugar levels (what a surprise), and sometimes (such as when experiencing a hypo), that’s what’s needed.

    Also, when it comes to sugar, a word on fruit:

    Not all fruits are equal, and some fruits can help maintain stable blood sugar levels! Read all about it:

    Fruit Intake to Prevent and Control Hypertension and Diabetes

    Artificial sweeteners are must-haves for diabetics

    Whereas sugar is a known quantity to the careful diabetic, some artificial sweeteners can impact insulin sensitivity, causing blood sugars to behave in unexpected ways. See for example:

    The Impact of Artificial Sweeteners on Body Weight Control and Glucose Homeostasis

    If a diabetic person is hyper, they should exercise to bring their blood sugar levels down

    Be careful with this!

    • In the case of type 2 diabetes, it may (or may not) help, as the extra sugar may be used up.
    • Type 1 diabetes, however, has a crucial difference. Because the pancreas isn’t making insulin, a hyper (above a certain level, anyway) means more insulin is needed. Exercising could do more harm than good, as unlike in type 2 diabetes, the body has no way to use that extra sugar, without the insulin to facilitate it. Exercising will just pump the syrupy hyperglycemic blood around the body, potentially causing damage as it goes (all without actually being able to use it).

    There are other ways this can be managed that are outside of the scope of this newsletter, but “be careful” is rarely a bad approach.

    Read more, from the American Diabetes Association:

    Exercise & Type 1 Diabetes

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  • The Real Benefit Of Genetic Testing
  • Green Tea Allergies and Capsules

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    It’s Q&A Day at 10almonds!

    Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!

    In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!

    As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!

    So, no question/request too big or small

    ❝Hey Sheila – As always, your articles are superb !! So, I have a topic that I’d love you guys to discuss: green tea. I used to try + drink it years ago but I always got an allergic reaction to it. So the question I’d like answered is: Will I still get the same allergic reaction if I take the capsules ? Also, because it’s caffeinated, will taking it interfere with iron pills, other vitamins + meds ? I read that the health benefits of the decaffeinated tea/capsules are not as great as the caffeinated. Any info would be greatly appreciated !! Thanks much !!❞

    Hi! I’m not Sheila, but I’ll answer this one in the first person as I’ve had a similar issue:

    I found long ago that taking any kind of tea (not herbal infusions, but true teas, e.g. green tea, black tea, red tea, etc) on an empty stomach made me want to throw up. The feeling would subside within about half an hour, but I learned it was far better to circumvent it by just not taking tea on an empty stomach.

    However! I take an l-theanine supplement when I wake up, to complement my morning coffee, and have never had a problem with that. Of course, my physiology is not your physiology, and this “shouldn’t” be happening to either of us in the first place, so it’s not something there’s a lot of scientific literature about, and we just have to figure out what works for us.

    This last Monday I wrote (inspired in part by your query) about l-theanine supplementation, and how it doesn’t require caffeine to unlock its benefits after all, by the way. So that’s that part in order.

    I can’t speak for interactions with your other supplements or medications without knowing what they are, but I’m not aware of any known issue, beyond that l-theanine will tend to give a gentler curve to the expression of some neurotransmitters. So, if for example you’re talking anything that affects that (e.g. antidepressants, antipsychotics, ADHD meds, sleepy/wakefulness meds, etc) then checking with your doctor is best.

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  • Chiropractors have been banned again from manipulating babies’ spines. Here’s what the evidence actually says

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Chiropractors in Australia will not be able to perform spinal manipulation on children under the age of two once more, following health concerns from doctors and politicians.

    But what is the spinal treatment at the centre of the controversy? Does it work? Is there evidence of harm?

    We’re a team of researchers who specialise in evidence-based musculoskeletal health. I (Matt) am a registered chiropractor, Joshua is a registered physiotherapist and Giovanni trained as a physiotherapist.

    Here’s what the evidence says.

    Dmitry Naumov/Shutterstock

    Remind me, how did this all come about?

    A Melbourne-based chiropractor posted a video on social media in 2018 using a spring-loaded device (known as the Activator) to manipulate the spine of a two-week-old baby suspended upside down by the ankles.

    The video sparked widespread concerns among the public, medical associations and politicians. It prompted a ban on the procedure in young children. The Victorian health minister commissioned Safer Care Victoria to conduct an independent review of spinal manipulation techniques on children.

    Recently, the Chiropractic Board of Australia reinstated chiropractors’ authorisation to perform spinal manipulation on babies under two years old. But this week, it backflipped, following heavy criticism from medical associations and politicians.

    What is spinal manipulation?

    Spinal manipulation is a treatment used by chiropractors and other health professionals such as doctors, osteopaths and physiotherapists.

    It is an umbrella term that includes popular “back cracking” techniques.

    It also includes more gentle forms of treatment, such as massage or joint mobilisations. These involve applying pressure to joints without generating a “cracking” sound.

    Does spinal manipulation in babies work?

    Several international guidelines for health-care professionals recommend spinal manipulation to treat adults with conditions such as back pain and headache as there is an abundance of evidence on the topic. For example, spinal manipulation for back pain is supported by data from nearly 10,000 adults.

    For children, it’s a different story. Safer Care Victoria’s 2019 review of spinal manipulation found very few studies testing whether this treatment was safe and effective in children.

    Studies were generally small and were of poor quality. Some of those small, poor-quality studies, suggest spinal manipulation provides a very small benefit for back pain, colic and potentially bedwetting – some common reasons for parents to take their child to see a chiropractor. But overall, the review found the overall body of evidence was very poor.

    Baby clutching ear, crying
    Spinal manipulation doesn’t seem to help young children with an ear infection. MIA Studio/Shutterstock

    However, for most other children’s conditions chiropractors treat – such as headache, asthma, otitis media (a type of ear infection), cerebral palsy, hyperactivity and torticollis (“twisted neck”) – there did not appear to be a benefit.

    The number of studies investigating the effectiveness of spinal manipulation on babies under two years of age was even smaller.

    There was one high-quality study and two small, poor quality studies. These did not show an appreciable benefit of spinal manipulation on colic, otitis media with effusion (known as glue ear) or twisted neck in babies.

    Is spinal manipulation on babies safe?

    In terms of safety, most studies in the review found serious complications were extremely rare. The review noted one baby or child dying (a report from Germany in 2001 after spinal manipulation by a physiotherapist). The most common complications were mild in nature such as increased crying and soreness.

    However, because studies were very small, they cannot tell us anything about the safety of spinal manipulation in a reliable way. Studies that are designed to properly investigate if a treatment is safe typically include thousands of patients. And these studies have not yet been done.

    Why do people see chiropractors?

    Safer Care Victoria also conducted surveys with more than 20,000 people living in Australia who had taken their children under 12 years old to a chiropractor in the past ten years.

    Nearly three-quarters said that was for treatment of a child aged two years or younger.

    Nearly all people surveyed reported a positive experience when they took their child to a chiropractor and reported that their child’s condition improved with chiropractic care. Only a small number of people (0.3%) reported a negative experience, and this was mostly related to cost of treatment, lack of improvement in their child’s condition, excessive use of x-rays, and perceived pressure to avoid medications.

    Many of the respondents had also consulted their GP or maternity/child health nurse.

    What now for spinal manipulation in children?

    At the request of state and federal ministers, the Chiropractic Board of Australia confirmed that spinal manipulation on babies under two years old will continue to be banned until it discusses the issue further with health ministers.

    Many chiropractors believe this is unfair, especially considering the strong consumer support for chiropractic care outlined in the Safer Care Victoria report, and the rarity of serious reported harms in children.

    Others believe that in the absence of evidence of benefit and uncertainty around whether spinal manipulation is safe in children and babies, the precautionary principle should apply and children and babies should not receive spinal manipulation.

    Ultimately, high quality research is urgently needed to better understand whether spinal manipulation is beneficial for the range of conditions chiropractors provide it for, and whether the benefit outweighs the extremely small chance of a serious complication.

    This will help parents make an informed choice about health care for their child.

    Matt Fernandez, Senior lecturer and researcher in chiropractic, CQUniversity Australia; Giovanni E. Ferreira, NHMRC Emerging Leader Research Fellow, Institute of Musculoskeletal Health, University of Sydney, and Joshua Zadro, NHMRC Emerging Leader Research Fellow, Sydney Musculoskeletal Health, University of Sydney

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • What are the most common symptoms of menopause? And which can hormone therapy treat?

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    Despite decades of research, navigating menopause seems to have become harder – with conflicting information on the internet, in the media, and from health care providers and researchers.

    Adding to the uncertainty, a recent series in the Lancet medical journal challenged some beliefs about the symptoms of menopause and which ones menopausal hormone therapy (also known as hormone replacement therapy) can realistically alleviate.

    So what symptoms reliably indicate the start of perimenopause or menopause? And which symptoms can menopause hormone therapy help with? Here’s what the evidence says.

    Remind me, what exactly is menopause?

    Menopause, simply put, is complete loss of female fertility.

    Menopause is traditionally defined as the final menstrual period of a woman (or person female at birth) who previously menstruated. Menopause is diagnosed after 12 months of no further bleeding (unless you’ve had your ovaries removed, which is surgically induced menopause).

    Perimenopause starts when menstrual cycles first vary in length by seven or more days, and ends when there has been no bleeding for 12 months.

    Both perimenopause and menopause are hard to identify if a person has had a hysterectomy but their ovaries remain, or if natural menstruation is suppressed by a treatment (such as hormonal contraception) or a health condition (such as an eating disorder).

    What are the most common symptoms of menopause?

    Our study of the highest quality menopause-care guidelines found the internationally recognised symptoms of the perimenopause and menopause are:

    • hot flushes and night sweats (known as vasomotor symptoms)
    • disturbed sleep
    • musculoskeletal pain
    • decreased sexual function or desire
    • vaginal dryness and irritation
    • mood disturbance (low mood, mood changes or depressive symptoms) but not clinical depression.

    However, none of these symptoms are menopause-specific, meaning they could have other causes.

    In our study of Australian women, 38% of pre-menopausal women, 67% of perimenopausal women and 74% of post-menopausal women aged under 55 experienced hot flushes and/or night sweats.

    But the severity of these symptoms varies greatly. Only 2.8% of pre-menopausal women reported moderate to severely bothersome hot flushes and night sweats symptoms, compared with 17.1% of perimenopausal women and 28.5% of post-menopausal women aged under 55.

    So bothersome hot flushes and night sweats appear a reliable indicator of perimenopause and menopause – but they’re not the only symptoms. Nor are hot flushes and night sweats a western society phenomenon, as has been suggested. Women in Asian countries are similarly affected.

    Woman sits on chair, looking deflated
    You don’t need to have night sweats or hot flushes to be menopausal.
    Maridav/Shutterstock

    Depressive symptoms and anxiety are also often linked to menopause but they’re less menopause-specific than hot flushes and night sweats, as they’re common across the entire adult life span.

    The most robust guidelines do not stipulate women must have hot flushes or night sweats to be considered as having perimenopausal or post-menopausal symptoms. They acknowledge that new mood disturbances may be a primary manifestation of menopausal hormonal changes.

    The extent to which menopausal hormone changes impact memory, concentration and problem solving (frequently talked about as “brain fog”) is uncertain. Some studies suggest perimenopause may impair verbal memory and resolve as women transition through menopause. But strategic thinking and planning (executive brain function) have not been shown to change.

    Who might benefit from hormone therapy?

    The Lancet papers suggest menopause hormone therapy alleviates hot flushes and night sweats, but the likelihood of it improving sleep, mood or “brain fog” is limited to those bothered by vasomotor symptoms (hot flushes and night sweats).

    In contrast, the highest quality clinical guidelines consistently identify both vasomotor symptoms and mood disturbances associated with menopause as reasons for menopause hormone therapy. In other words, you don’t need to have hot flushes or night sweats to be prescribed menopause hormone therapy.

    Often, menopause hormone therapy is prescribed alongside a topical vaginal oestrogen to treat vaginal symptoms (dryness, irritation or urinary frequency).

    Doctor talks to woman
    You don’t need to experience hot flushes and night sweats to take hormone therapy.
    Monkey Business Images/Shutterstock

    However, none of these guidelines recommend menopause hormone therapy for cognitive symptoms often talked about as “brain fog”.

    Despite musculoskeletal pain being the most common menopausal symptom in some populations, the effectiveness of menopause hormone therapy for this specific symptoms still needs to be studied.

    Some guidelines, such as an Australian endorsed guideline, support menopause hormone therapy for the prevention of osteoporosis and fracture, but not for the prevention of any other disease.

    What are the risks?

    The greatest concerns about menopause hormone therapy have been about breast cancer and an increased risk of a deep vein clot which might cause a lung clot.

    Oestrogen-only menopause hormone therapy is consistently considered to cause little or no change in breast cancer risk.

    Oestrogen taken with a progestogen, which is required for women who have not had a hysterectomy, has been associated with a small increase in the risk of breast cancer, although any risk appears to vary according to the type of therapy used, the dose and duration of use.

    Oestrogen taken orally has also been associated with an increased risk of a deep vein clot, although the risk varies according to the formulation used. This risk is avoided by using estrogen patches or gels prescribed at standard doses

    What if I don’t want hormone therapy?

    If you can’t or don’t want to take menopause hormone therapy, there are also effective non-hormonal prescription therapies available for troublesome hot flushes and night sweats.

    In Australia, most of these options are “off-label”, although the new medication fezolinetant has just been approved in Australia for postmenopausal hot flushes and night sweats, and is expected to be available by mid-year. Fezolinetant, taken as a tablet, acts in the brain to stop the chemical neurokinin 3 triggering an inappropriate body heat response (flush and/or sweat).

    Unfortunately, most over-the-counter treatments promoted for menopause are either ineffective or unproven. However, cognitive behaviour therapy and hypnosis may provide symptom relief.

    The Australasian Menopause Society has useful menopause fact sheets and a find-a-doctor page. The Practitioner Toolkit for Managing Menopause is also freely available.The Conversation

    Susan Davis, Chair of Women’s Health, Monash University

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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