Dr. Stillman's Guide to Balancing Hormones in Menopause

Relief from hot flashes, fatigue, brain fog, and more

Are you struggling with fatigue, brain fog, anxiety, racing thoughts, panic attacks, hot flashes, thinning hair, skin, and nails, loss of muscle mass, or insomnia?

This is what women going through menopause are universally struggling with (in some combination).

In this post, we're going to talk about what these symptoms mean in terms of hormone levels and hormone balance.

For the record, many of these symptoms are just symptoms of light deficiency.

Many women have told me over the years that their symptoms of hormonal imbalance resolved with light therapy. Here’s my guide to light therapy for menopause:

Light Therapy for Menopause

Many people who are writing about hormones are writing about how to balance them in women who are pre-menopausal. I'm NOT writing about that here. I am writing about how we use prescription hormones (we use bioidenticals, for the record).

We use bioidentical hormones in my practice daily, because as we discussed in a recent post and podcast, they are vital for optimal health as we age.

Interview with Dr. Rosensweet | Author of Happy Healthy Hormones

I decided I needed to create a quick guide to how we balance them, and I have decided to share it with you.

First, which hormones are we talking about here?

I'm going to address:

• Progesterone

• Estrogen

• Testosterone

• DHEA

What do each of these hormones do?

Each hormone has a unique list of signs and symptoms that you see when they are present in excess, and when they are absent or deficient.

Progesterone deficiency looks like:

• Anxiety

• Racing thoughts

• Inability to sleep through the night

• Hot flashes

• Heavy periods

• Excessively painful periods

• Progesterone excess looks like:

• Drowsiness

• Estrogen deficiency looks like:

• Hot flashes

• Brain fog

• Fatigue

Estrogen excess looks like:

• Testosterone deficiency looks like:

• Loss of muscle mass

• Lack of drive

• Fatigue

• Testosterone excess looks like:

• Excess hair growth

• Aggressiveness

We share these ideas with women in one simple graphic that I’m including:

Finding Your Optimal Dose (1)

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DHEA deficiency looks, in most respects, like testosterone deficiency, which is why I generally use them together (in the same bottle).

These are the symptoms of menopause and post-menopause. The rollercoaster of symptoms that women feel during menopause is due to imbalances of these hormones relative to one another.

The concept of "hormone balance" is crucial here. For example, estrogen "excess" can be masked by excessive doses of progesterone. Many symptoms of testosterone deficiency can be masked by estrogen and progesterone.

The key to optimal health is balancing these hormones.

What about breast cancer? We addressed that in this post and podcast.

So how do we balance hormones?

Obviously, we can increase them or decrease them.

Here's the thing...

Hormones build up in our tissues. Progesterone, for example, can take weeks to be fully excreted from the body.

This means that if you increase your dose today, it may relieve your symptoms tomorrow, only to cause symptoms of excess in days or weeks.

For this reason, most practitioners only adjust hormones once every few weeks.

Patients who refuse to be patient with their symptoms can put themselves in a worse position than when they were on too low of a dose.

For this reason, many practitioners will have patients cycle their dose of hormones. I won't get into those details here - there are many ways to do this and in the end, it's up to your practitioner.

In the end, adjusting hormone doses boils down to one simple question.

Do you have symptoms of excess or deficiency for each hormone?

There is some overlap in signs and symptoms, which we discover by trial and error.

This is the simple version of titrating hormones to find your optimal dose. The reality is a bit trickier.

For example, I have seen hot flashes significantly reduced by ditching sunglasses, spending more time outside, and wearing blue blockers at night.

I could go on and on with examples like this, but in the end it boils down to all the advice I packed into my Gear Guide and my post on my daily routine. Go have a look at those. They are two of the best posts I've ever written.

Let me run you through a pretty typical example I see in daily practice.

• A woman going through menopause is having insufferable night sweats and is waking up at 2 or 3 AM with racing thoughts. Progesterone will get her sleeping through the night, and we can start estrogen to knock out her hot flashes.

• A woman going through menopause is suffering from brain fog. This is a cardinal symptom of estrogen deficiency, but we never give estrogen without progesterone. Even if she says her sleep is rock-solid (her sleep is probably mediocre to terrible), she will benefit from progesterone and this alone may reduce her brain fog. We then add estrogen.

• A woman going through menopause is struggling with new incontinence and gait instability. Rarely, this will be a truly neurological problem. The majority of the time, women are presenting with sarcopenia (muscle loss) due to lack of androgens (testosterone and DHEA). They also need progesterone and estrogen, but these alone won't fix their androgen deficit.

• A woman going through menopause is struggling with fatigue, brain fog, and constipation. She probably needs more thyroid hormone. And that's a topic for a future post.

I'll post a link to it my guide to thyroid when it comes out. Subscribe so you don't miss this and more great content.

Until next time, be well,

Dr. Stillman