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All About Menopause

Link to the Episode

Anshu Bahanda: This is Anshu Bahanda on Wellness curated. Thanks for joining me on this podcast. My mission is to empower you with health and wellness so that you can then go and empower others. Today, you have a leading light in endocrinology, Dr. Isabelle Bond. Dr. Isabelle graduated as a medical doctor in Paris, at the University of Pierre in Marie Curie, and she qualified in the specialty of endocrinology, metabolic diseases and nutrition. And she further specialised in functional medicine, which she has been practicing for over twelve years now. Tell me, what is wellness to you?

Dr. Isabelle Bond: It’s not only about the physiology and about the body, it’s also about the psyche, about the mental being in harmony with your body and I would even say for some people who are spiritual, that there is also that connection to the spirit, okay? And in functional medicine, we speak about the PNEI system, psycho, neuro, endocrine, immune, gut system, and it’s very important to understand this connection. We call it the mind-body connection, but it’s very important and it works in both ways. It is about plenitude, harmony between the psyche and the body, the mental and the physiology.

AB: Now tell me, let’s start talking about menopause, the topic that people are waiting for, for weeks. All women know that menopause is when someone stops having their period, right? So how would you explain it in terms of the systems and what are the clinical symptoms for menopause?

Dr. IB: Menopause, to understand the word, it’s menses and pause. So menses is the period we have every month. And pause means stop. So it’s a time when the periods stop. And we speak about proper menopause after one year without bleeding, but usually it’s over several months, sometimes years. So what is happening is that from about 12-15 years old until, let’s say, 50, the woman has a regular cycle or more or less regular cycle. And the estrogen goes up and down within a certain range between the follicular, the first part of the cycle, and the luteal phase, the second part of the cycle, and the progesterone is only secreted in that second part and it’s a wave of hormones that is more or less regular, that changes during pregnancy, of course, changes if you take contraceptives, but basically it’s these waves of hormones. At menopause, this estrogen, oestradiol, is going to start to diminish, but it doesn’t diminish at once. It’s going to go down, then up, down and up, and you can see clinically that women are going to have more and more scar cycles. They’re longer and longer or they could be shorter and shorter and then longer. So the hormones are definitely up and down. As the progesterone goes down more slowly,  it goes down progressively over several months or years. So these changes are going to affect, I would say, nearly all systems. And the main systems that are going to be affected are going to be the bones.

AB: The bones, Okay.

Dr. IB: The heart and the brain.

AB: Okay.

Dr. IB: But as also something that every woman I’m sure could report, it’s also a case of dryness, okay? So dry skin, dry hair, dry secretions of the vagina, dry vagina, dry bladder. So it’s very important that women have storage and receptors to nearly every cell in her body and also into the brain and the progesterone is the same. So this diminution is going to affect the bone, we know it’s going to induce osteoporosis. It’s going to affect the heart, we know that after 50 years of cardiovascular risk, the disease of cardiovascular disease in women is reaching the level of cardiovascular disease in men, and that is very important to understand because a lot of women are scared of breast cancer. But do they realize that women in general are going to die twice more of a cardiovascular disease when a woman is not treated? and this is the first cause of death.

AB: Oh wow.

Dr. IB: And the third system that is really affected is the brain, okay? You have quite a lot of women who are going to have signs of depression, signs of anxiety, they’re going to have memory issues and all of that is because we know that the estrogen, well, I say the estrogen because women have three estrogen-estradiol, estriol and estrone. But the main one is an estradiol. And the progesterone, they have receptors in the brain too. So it’s definitely going to affect all these functions, cognitive function and the emotions of the woman. Another system, if I can speak, is all the systems of the mucosa, like in your mouth, in your intestine, in your vagina, in your bladder, so all this tissue is really moist by the steroid . Estrogen and progesterone are steroids and I’m sure all women realize if they’re not treated, this tissue dries up with all the consequences-urinary infection, vaginal dryness, difficulty during intercourse and so on.

AB: Before we carry on further, I want you to clarify one thing to us. What period would you say is menopause?

Dr. IB: The term menopause is the time when a woman after one year never had or experienced a period and that corresponds, biologically speaking, to the rise of the FSH, the follicle stimulating hormone coming from the Hypophysis and it’s going to rise and achieve a plateau. When that FSH is at a plateau, that’s what we call the menopause.

AB: You’re saying to me that it carries on, the effects of it carry on. It doesn’t stop when the period stops for a year. So that’s a very important point for everyone to hear. Dr. Isabelle has said that it affects the bone, the heart and the brain. But what we need to be aware of is mainly mucosa, which is it causes dryness in every plot of the organs of the body. Whether it’s the skin, whether it’s vagina or the gut lining, which is interesting because even in vata, they say in ayurveda, we can’t go onto the vata phase of our lives. The important point here is it doesn’t stop with the period. I want you to explain to us exactly what happens to the hormones before, during and after the process. 

Dr. IB: So I’m going to start with the FSH, because we were speaking about the FSH. So it’s a hormone coming from the brain, the Hypophysis stimulating the follicles. The woman is born with a set number of follicles, so the little baby girl, when she’s born, has a set number of follicles that are going to remain for her. That’s a set number and that stays stable until the little girl arrives at teenage time, and then she’s going to start to have her period. So every time, every month, you have a cohort of follicles that comes, are stimulated by the FSH, end up with one follicle that we call the degrasse follicle, which is going to be the egg, which is released in the tuba, progressively arriving in the uterus and if it’s vacant, then it’s going to have a baby, otherwise it’s going to be eliminated at the next period. These follicles have cells that secrete the estrogen. At time of ovulation, when the egg is released, the scar of that follicle is called copious luteum. And that copious luteum starts to secrete the progesterone, which is in the second part of the luteal phase, and also the estrogen. So the estrogen has a peak during the follicular phase and a second peak during the luteal phase. And the progesterone is only secreted during the luteal phase. So what happens at menopause is that the quality of the eggs, the eggs are of the age of the lady.

AB: Okay.

Dr. IB: So if the lady is 50, the egg is 50. It’s not like in men where the sperms are regularly secreted and produced every month. That egg is 50 years old, so the quality of that follicle is really not optimal and the secretion of estrogen and progesterone is going to diminish little by little and during this time the hormones vary, but towards the diminution of the secretion.

AB: So now tell me what happens to women emotionally. You were talking about how it affects their brain.

Dr. IB: Women have receptors to estrogen, to nearly every part of their body, but specifically in the brain, we have receptors for estrogen in the hypophysis, hypothalamus, amygdala and hippocampus in the brain that have a big impact on emotion and they’re also the place where you have the dopamine, the serotonin, the GABA secretion. When they diminish, they’re going to have less of an impact on these cells, on the neurons, and these neurons are going to be less produced. So serotonin is related to happiness. So we’re going to have a diminution in serotonin. So women are going to feel more depressed.

AB: Okay.

Dr. IB: The other neurotransmitter which is affected is dopamine. So dopamine is the decision making neurotransmitter. It’s a working memory.

AB: Interesting.

Dr. IB: The other neurotransmitter which is affected a little bit more specifically from the progesterone is GABA. GABA is absolutely key to soothe anxiety. If you have a diminution of GABA, the woman is going to start to have anxiety, palpitation and feel really unwell.

AB: What to do with the menopause tummy, as it’s called, and the weight gain?

Dr. IB: Weight gain ,and what we call the tummy gain, is again related to the diminution of the estrogen and progesterone, but more specifically, the estrogen. So the body is very clever. The woman needs a little bit of secretion of estrogen. And as it happens, the fat cells, the adipose tissue, are secreting estrogen, we know that. So it’s not a huge secretion like the ovaries, but they do secrete estrogen. So it’s like a backup system by the body to protect the woman from those severe deficiencies that happen at menopause, that’s why it’s so difficult to get rid of it.

AB: And what about night sweats and sleeplessness?

Dr. IB: So the night sweat is part of the FSH rising progressively to a plateau. I’m not sure we understand what the system or the connection is.

AB: Okay.

Dr. IB: Lack of sleep or the difficulty sleeping due to the diminution of the progesterone. So as it diminishes, for sure the sleep is going to be not as good. And you have the GABA diminishing. So you have women who experience anxiety, waking up about 3-4 O’clock in the morning with anxiety, not sleeping, not able to return to sleep. That’s all related to the progesterone gently diminishing.

AB: Dr. Isabel, also talk to me about sexual desire in women when they’re going through menopause and after.

Dr. IB: So hormones, the secretion of the estrogen are diminishing. As I mentioned earlier, it creates dryness. It’s not going to provide a very healthy biofilm. So the biofilm, if you put your tongue inside the mouse on your gum, you can feel it’s very thick. So that is drying because the steroid, the estrogen and progesterone are giving like a bed of nutrition for this biofilm to be very healthy and moist. So the vagina is going to start to dry and diminish, also anatomically. So intercourse is going to become painful or sometimes not possible. Another hormone that I didn’t mention so far is testosterone. So the testosterone is also separated in the woman’s body about 50 times less than in the gentleman. But it’s also quite important for energy and the libido. And again, that hormone is diminishing during perimenopause and menopause. So the combination of this hormone diminishes inducing loss of interest in sexual intercourse.

AB: So then tell me, we’ve gone through a lot of the changes and a lot of things that people experience. What else have I left out?

Dr. IB: Something else we could speak about is joints. Depending on your genetic background, the effect on the estrogen in the different tissues is going to be different. Some women, one of the symptoms they come with is joint pain. And again, we’re not sure what is the connection between the cartilage cells and the estrogen, but it’s definitely one symptom that we do notice.

AB: As far as I know, and correct me if I’m wrong, we have HRT and we have alternative treatments. So will you talk us through both?

Dr. IB: Yeah. What I use, which is BHRT, is bioidentical hormone replacement therapy. What we’re speaking about when we say hormones, it’s a big basket, like a big basket of fruits, but you’re not going to compare an apple to a berry, okay? So it’s exactly the same with hormones. And a woman should be substituted only with natural hormones.

AB: So that’s a very important point you’ve made, that if you decide to go for HRT, only go for natural hormones.

Dr. IB: You have a combination of natural estradiol with some progestative. Personally, that’s my personal opinion. I don’t like this combination because I don’t know what I’m going to give on a long-term basis. We have had natural progesterone since even before and now we have, in terms of natural estrogen, we have patches, we have creams, the gel, we have lozenge that you put under your tongue. So there are several formulations that you can take.

AB: I want to clarify, if you do decide to go for HRT, you said make sure it’s natural. How do you think should it be taken, to be administered?

Dr. IB: It depends. What is the wish of the lady and the age of the lady? If a lady comes to see me and she’s still between 45 and 50, she’s going to need a much higher level than a lady who’s maybe 70 or 80.

AB: Right.

Dr. IB: So depending on the age of the lady, I’m going to choose. Usually I like to choose the Lozenge that you put under the tongue, and you can give estriol, which is really nice for the skin. You can add testosterone, very low dosage, 0.1 milligram, and other hormones I didn’t mention before, but which are also very nice to add, are the DHEA, the pregnenolone. So they are adrenal hormones, but that really helps women and aging, they’re very good for that also. And the progesterone, you put it in the capsules, for example, with olive oils or whatever like it progesterone, you find very easily on the market. And then, depending on the age, also of the woman, you can do cyclical variations. So if you give the estrogen the whole month and the progesterone the second part of the month , some ladies are going to have a higher risk of developing breast cancer. Now remember, breast cancer is going to develop over between five to ten years. So it’s not something that happens overnight, okay? It’s a very slow process. I’m speaking of the tumors that happen in women after 50. I’m not speaking of breast cancer in young women, which is a completely different story and far more aggressive. So depending on the family history. So you have to do a proper check, and then you’re going to have a variation, a modulation of the dosage you’re going to give to the lady. I always check how these hormones are detoxified by the liver. So we have two means to see how the liver is detoxifying, these hormones- you can do a genetic testing, a liver detox, genetic testing, and the other test I do is in the urine to see, depending on your lifestyle and nutrition, how this liver is doing this detoxification-and based on these two results. So I do it at the beginning, I can adapt and choose a dosage. And it’s something I discussed with my patient. Again, when we say, “oh, my mother had breast cancer”, immediately, I think genetic, but genetic in the liver and what is also the environment, the nutrition. Are you obese? Are you smoking? Do you drink a lot of alcohol? So all of that, it’s big information you need to gather, then you choose formulation and the dosage.

AB: If anyone has fibroids in their uterus or fibrous breasts, they need to be very careful about a woman who has a fibroid.

Dr. IB: Endometriosis fibrous breast is usually because , and there’s nothing 100% in biology and in the human species, is usually lady who has probably what I call a hyperestrogenic terrain dominance. And that happens when the liver cannot detoxify the hormones very well. So you have two choices here. Either you change the lifestyle and the nutrition of the lady to optimize that detoxification, this is not in their horizon, they don’t want to change anything. And yes, you would diminish a little bit, especially women who have fibroids, because if you give hormones, they might bleed again,so you need to change the dosage. An exception where I would use it for a short time, Progestin, to dry up the fibroids,so that you have to adapt.

AB: If someone starts on HRT, maybe just before or during menopause, would you recommend that they keep taking it for years after for the rest of their life?

Dr. IB: There is what the medical school and the colleges say, and then there is my opinion. So if you speak in general, the gynae, they’re going to tell you it’s good for ten years, then you stop, except that let’s say, a woman starts her menopause at 45 and you want her to stop at 55, that’s not going to work, I’m sorry. A 55 year old woman today is still young, active with job and so on, you cannot tell her to stop. Me in my personal opinion, because I follow groups in the USA, like Worldlink, Desrosiers, they have years of experience with bioidentical hormones and they have their woman and these women wish… So they have women in their 80s freezing their hormones. Now, I’m not saying that the dosage is the same, maybe you want to diminish it a little bit, but it depends for every case on the history of the woman and her activity. So that’s very important.

AB: And tell me about alternative treatments.

Dr. IB: If someone decides not to get HRT, we have a homeopathy product like Acteane from Boiron in France. A-C-T-E-A-N-E. It’s a product from Boiron. Boiron is the name of a homeopathic company in France. All these natural options are going to work quite beautifully on the hot flashes and the night sweat, like the herbs you have the black cohosh, you have the evening primrose oil, you have the sage, you have essential oils, the lavender, all of that works quite well. But none of them, as far as I know, is going to protect the bones, the brain, or the heart.

AB: Okay, so that’s interesting. I would definitely ask a homeopath about that as well. But that’s interesting what you’re saying, and it’s a very important point for all of us to note that we need to find out what will help our bones, brain and heart optimally.

Dr. IB: Yes because it’s something that doesn’t happen overnight. It’s something that the woman is going to experience after the year goes on and now the life expectancy of the woman is reaching 90. So the message is to do a thorough medical history check, a family history check, and understand how the woman is detoxifying the hormones. I always support DIM, Diindolylmethane, which is an extract of broccoli, which helps the liver to detox the hormones. All women I treat have this and sometimes CDG, CD Gluconate, which helps some enzyme we have in our guts that recycle the hormones. We don’t want that when we do HRT or BHRT. So look at all the environment and then make your choice of the formulation, the dosage, and for ME, as long as it can be.

AB: Do you have any advice?

Dr. IB: Yeah, I would say get educated with books or papers.

AB: What can trigger breast cancer? And I know that’s a question, which is very interesting.

Dr. IB: Obesity can be a risk factor. It’s not a trigger, it’s a risk factor. So it’s very important to understand the difference. It’s not something you have and it switches on breast cancer. That’s not how it works. There are risk factors. So obesity is a risk factor. Smoking is a risk factor. Lack of exercise is a risk factor. Alcohol is a risk factor. And then your genes, your genetics, but they’re exceptions always. In medicine, there is nothing 100%.

AB: Thank you so much. We were talking to Dr. Isabelle Bond. Thanks for joining us. Hope you enjoyed the Wellness curated podcast. Please subscribe and tell your friends and family about it. And here’s to you, leading your best life.