Menopause, a point in a woman’s life 12 months after her last period, still seems to create angst because of all the negative stigma that has been attached to it over the years. In the 1700’s, when a woman was going through this transition, she was automatically prescribed opium because the medical understanding of menopause was minimal. Generally diagnosed with hysteria, a few centuries later, doctors recommended valium for what was likely nothing more than mood swings. In our more enlightened times, mood swings became associated with this inevitable and natural stage of a woman’s life that has three phases—perimenopause, menopause and post-menopause. Other common issues associated with these phases are vaginal dryness, reduced sex drive, weight gain, sleep problems, brain fog, hot flashes, night sweats, irritability, depression and anxiety.

According to the National Institute on Aging, the phases in total last about seven years from beginning to end but can be as long as 14 years. The duration depends on variable lifestyle factors such as smoking, the age when it begins, race and ethnicity. During perimenopause, the body's production of estrogen and progesterone, two hormones made by the ovaries, varies greatly and the transition affects each woman differently. Her body begins to use energy in different ways, fat cells change and she may gain weight more easily. Women can also experience changes in bone or heart health, body shape, composition or physical functioning.

Acupuncture for Menopausal Symptoms

“Menopause is not a disease. It’s nothing women should fear,” says Doctor of Oriental Medicine (DOM) Terri Evans, owner of Tae Healthy Aging, in Naples. “It is simply another transition in life, one in which women are recognized for their wisdom and power as elders, if they can get beyond the societal stigma that their child-bearing purpose is over. We fully understand the transition from childhood through puberty into the stage of giving birth and nurturing children. Now we need to begin understanding and learning the purpose for this natural transition that in Indigenous cultures such as the Iroquois and Navajo, is celebrated as a welcomed transition to community leaders and an increase in status for older women.

“I don’t treat uncomfortable symptoms of this transition; I seek out the imbalance that is creating the symptoms and address that. I do this with functional medicine. Many times, it is an imbalance in function that is misunderstood. I get the person back to function, and the symptoms are less uncomfortable. Sometimes it is necessary to treat the anxiety of the stigma of menopause with an acupuncture balance treatment for stress,” says Evans, who often refers patients with more difficult menopausal symptoms to Xiu Qiong Cen, DOM, at the Acupuncture Center of Naples, or Phyllis Weber, a licensed acupuncturist and owner of Gulf Coast Acupuncture & Herbs, in Fort Myers. Both acupuncturists specialize in menopause.

Bioidentical Hormone Replacement Therapy

The earliest sign of changes, vaginal dryness, occurs in perimenopause between the ages of 40 to 44. According to Dr. Lindsey Berkson, author of Safe Hormones Smart Women, this is a flashing red light. “It’s insufficient hormone signaling, the body’s warning that bones are beginning to thin, the brain’s structure, activity and neuron connectivity are beginning to decline, and the aging process has begun. This is the perfect time to begin bioidentical hormone replacement therapy (HRT). Treating only the vagina is minimized medicine. It’s so important to find a doctor who practices functional medicine, has completed continuing education hours in HRT and nutrition and who has experience in these areas,” says Berkson, who practices at the Naples Center for Functional Medicine (NCFM) and is presently a continuing education professor for doctors and pharmacists.

Berkson recalls a presentation she gave for the North Carolina Integrative Medical Society regarding the vindication of estrogen, especially in high-risk patients such as those with breast cancer. She presented the results of 41 studies conducted at such prestigious institutions as the University of Texas MD Anderson Cancer Center and Harvard Medical School. “The female breast cancer patients were given estrogen after their treatment and went on to have less recurrence and fewer deaths. Even if they had recurrences, they had a much higher quality of life.

“Most of what doctors learn in medical school about hormones is minimal, if they receive any instruction at all. What they do learn is wrong, especially in relationship to cancer. Many doctors and patients incorrectly think that hormones cause or drive cancer, or they don’t believe in them. Not only is this mindset unfair for patients, it’s also physiologically and scientifically inaccurate. Hormones are the most powerful physiological signaling molecules in our body. They rule our brains, gut, kidneys, blood vessels and even our vocal cords,” says the author of 21 books focused on hormones, antiaging and medical nutrition, particularly for breast cancer survivors. One of her books, Hormone Deception, is a textbook in numerous colleges and universities.

NCFM now includes HRT administered by tiny pellets inserted under the skin. The pellets provide steady, predictable, time-released dosages compared to other methods of delivering HRT, including creams, pills and patches. The pellets, which are the size of a grain of rice and are inserted near the hip, contain compounded hormones made from organic plant material with the bioidentical molecular structure of naturally occurring hormones.

Nutritional Support

“I'm a big proponent of HRT, but I really want to know the genetics before I put women on bioidentical hormones, says registered dietician-nutritionist and Institute of Functional Medicine-certified practitioner, Dee Harris. If a woman can't detox estrogen, she’s more at risk for breast cancer, as well as endometriosis and fibroids, both conditions that affect the uterus. I use the DUTCH Test to measure the inactive byproducts, known as metabolites of estrogen, which are excreted in urine. Estrogen metabolites can be "good" or "bad", depending on the pathway. The 2-hydroxy pathway is considered "good" because it has the lowest risk for cancer. The 16-hydroxy and 4-hydroxy pathways are considered "bad" because they are associated with higher risks of breast cancer. The best workaround I have for women who fall into this category is supplementation with specialized formulations of diindolylmethane (DIM), a phytonutrient found in cruciferous vegetables including broccoli, cabbage, cauliflower and kale. It helps them detox estrogen that is dangerous at higher levels.

Harris asks many women who go through menopause experience hot flashes and night sweats about their history to determine if they had terrible premenstrual syndrome earlier in life. “If they did, it’s likely they had difficulty with hormones to begin with. As functional medicine practitioners, we have different supplements that help promote healthy estrogen levels, detoxing or to alleviate their perimenopausal or menopausal symptoms. We also have medicinal-grade substitutes for women dealing with symptoms who don’t want to do HRT, things like wild yam, a phytoestrogen for relieving vaginal dryness and hot flashes or chaste berry an herb for PMS, sleep and mood swings,” advises Harris who often refers menopausal women out to Sheri Clary, a physician assistant who works out of two compounding pharmacies in Naples.

Digital Infrared Thermal Imaging (DITI)

According to PubMed Central, for women over 60 that are concerned about breast cancer, diet and lifestyle changes are essential as preventative measures, along with early detection. “While most medical care providers rely on the mammogram for early detection, there is another tool, thermography. This noninvasive adjunctive diagnostic screening procedure focuses on abnormalities in the physical or anatomical structure within the breast. An infrared scanning device is used to convert infrared radiation emitted from the skin surface into electrical impulses that are visualized in color on a monitor. Medical DITI’s major clinical value is in its high sensitivity to pathology in the vascular, muscular, neural and skeletal systems, and as such, can contribute to the pathogenesis and diagnosis made by a clinician that interprets them,” advises Kim Lemons, owner of Sun Coast Thermal Imaging, LLC, in Cape Coral. An obstacle to medical professionals embracing thermography is that it is missing from the curriculum of medical schools, which means that doctors know little about it. 

Lemons sees thermography as a commonsense option for women that intuitively have concerns about the potential harm of mammography’s repeated radiation exposure and breast compression. The National Cancer Institute has noted potential harms due to radiation exposure, and a study published in the British Journal of Radiobiology states that the type of radiation used in X-ray-based screenings is more carcinogenic than previously believed.

Powering through the menopausal years is no longer necessary because there are functional medicine practitioners in the area to help and online organizations such as Women’s Health Network and The North American Menopause Society. Women can join Red Hot Mamas and start a support group in the area. Founder Karen Gilbrin designed the RedHotMamas.org website to help women understand that menopause is a normal life transition and to encourage women not to view it negatively.

D-Signed Nutrition, Bonita Bay Executive Center, 3531 Bonita Bay Blvd., Ste. 300, in Bonita Springs. 239-676-5249. D-SignedNutrition.com. 

D-Signed Nutrition, LLC - 3531 Bonita Bay Blvd, Ste 300, Bonita Springs, FL

Bonita Bay Executive CenterMedical Nutrition Therapy and health coaching that personalizes your program to restore health and wellness. Improve digestion, elimination, brain health, immun... Read More » 

Naples Center for Functional Medicine, 800 Goodlette Rd. N., Ste. 270, in Naples, 239-649-7400, NaplesCFM.com. 

Naples Center for Functional Medicine - 800 Goodlette Rd Ste 270, Naples, FL

Dr. Lindsey Berkson MA, DC, CNS, DACBN, CAN is a hormone scholar and functional medicine specialist focusing on hormones, anti-aging and medical nutrition at Naples Center for Functional ... Read More » 

Suncoast Thermal Imaging, 308 SE 43rd Ln., in Cape Coral; 239-540-1002, MedicalThermograms.com.

Tae Healthy Aging Center, 11983 Tamiami Tr. N., Ste. 100A, in Naples; 239-430-6800 TaeHealthyAging.com.