A Functional Medicine Approach to Menopause

By Wendy Warner, MD, FACOG, ABIHM

Posted on | By Wendy Warner, MD, FACOG, ABIHM

All gynecologists are taught that hot flashes and night sweats come from falling estrogen levels. Period. That means that when you go to see your doctor with these complaints, you’ll likely get a prescription for hormone replacement (HRT) and a long talk, since there are issues with HRT.

But stop and think about it: How can it just be from falling estrogen levels? That simply doesn’t make any sense, since every woman on the face of the planet drops her estrogen at menopause … and not all of us flash!  Also, many women continue to flash for years after their last period, long after their estrogen level should be more stable. And many folks can pretty much predict when it will happen: When they get upset, or when they eat something sugary or starchy. Think also about how you feel when you flash – you get hot, you get sweaty, your heart rate goes up, you might feel anxious. Doesn’t that feel more like someone came up and surprised you? Something like a panic attack – the fight or flight reaction? How can this be? 


It’s About More Than Estrogen

The part of our brain that regulates temperature responds to both estrogen and adrenaline (a stress hormone from your adrenal glands). We know that if the adrenaline level is normal (ie. low), then your estrogen level can be high or low, it doesn’t matter – you won’t flash. However, if the adrenaline level is chronically high (i.e. you spend a lot of time stressed out), any drop in the estrogen level will trigger a flash. Since many of us live busy, hectic lives, our adrenal hormones tend to be out of balance, so as soon as our estrogen starts to fall, this cascade of reactions kicks in and we start getting flashes. That’s why it’s important to look at adrenal function as well as estrogen levels when trying to manage menopausal symptoms.

The diet-related flashes are also pretty easy to explain: We know that when we eat sugary, starchy foods, our glucose level goes up. This makes our insulin kick in to control it; when the insulin rises, our cortisol goes with it. Cortisol is a hormone from the adrenal glands, and when it goes up and there’s no estrogen around to balance it, it triggers the same flashing that adrenaline does.

Article written by Wendy Warner, MD, FACOG, ABIHM