Meno-Minders
A Q&A forum with physician Dr. Robert Lemley ND, NCMP
Naturopathic Doctor, NAMS Certified Menopause Practitioner

Question:  Dr. Lemley, how do I know if I am in peri-menopause or menopause? And, what about my husband?

Snow White and the 7 Hormonal Dwarves

Remember the adoring tale of Snow White… the fair maiden princess who bit into the poisoned apple only to fall spell to her evil stepmother queen? Jealous of Snow White’s beauty, the vain and wicked witch coveted Snow White’s “lips as red as blood, hair as dark as the window frame, and skin as white as the snow.” Had the temperamental queen been living in modern times, she would not have needed to go to such lengths in order to be fairest in the land. The queen was likely going through menopause. She didn’t need the magic mirror on the wall. All she needed was a little estrogen.

After biting the apple, Snow White lay dormant in a glass coffin protected by seven friendly woodland creatures whom she had lived with briefly prior. These dwarves:  Happy, Sleepy, Sneezy, Grumpy, Bashful, Dopey and Doc, stood by Snow White’s coffin, keeping eternal vigil until she was awakened by her true love’s first kiss. When her Prince Charming broke the spell, he and Snow White rode off into the sunset and they lived happily ever after so we are told. But did they really? Did either know what was waiting ahead of them mid-life? To be more pointed, how charmed was the Prince when his beloved Snow White began living with a new group of mid-life hormonal dwarves called Itchy, Bitchy, Flashy, Drysey, Bingey, Bluesy and Chubby?

Mirror-mirror on the wall, what has become of this person after all??? The mirror answers:  “A maturing woman thus I see… for menopause is thee.”

Peri-menopause is the time leading up to menopause. Menopause gets defined as the time after going one full year without a menstrual cycle. Both can be unpleasant and demanding both physically and emotionally. For most women, symptoms are strong enough to interfere with quality of life. It is not uncommon to see changes stemming early in a woman’s 30’s. However, noted changes are more often found in the mid to late 40’s when the ratio of estrogen to progesterone becomes more pronounced. This has been termed “a dominant estrogen state.” Dominant estrogen can cause intense PMS including breast tenderness and abdominal bloating. Mood changes such as weepiness, irritability, anxiety and depression can be experienced and the cycle might become more heavy, scant, unpredictable or even absent. There may be concomitant fibroids or endometriosis. The ovaries will eventually begin shutting down their hormone production around the age of 50 give or take a few years. The subsequent disruption in estrogen production will cause hot flashes and night sweats. When severe, hot flashes interrupt daily activities and effect job performance. Night sweats are the leading cause of major sleep disruption for women in this age group. This alone has a profound effect on overall energy levels and mood by result of the sleep deprivation they cause. Forgetfulness, brain fog, food cravings, thinning skin, weight gain (5-15 pounds on average) and loss of libido can all be part of the package. As time goes on, not only will these hormonal dwarves cause Snow White to experience diminished desire for her Prince Charming, but she may also become averse to being intimate with him. Without estrogen, the pelvic region loses its tone. The result is an area that is more thin, friable, and dry, making intimacy uncomfortable. She may become more prone to pelvic infections and perhaps she may experience leaking with coughing, sneezing and laughing. Eventually that region of the body will yield to atrophic changes due to lack of estrogen which, if prescribed, will easily restore the integrity of the area thus facilitating comfort and quality of physical intimacy.

It’s not like Prince Charming is exempt from living with these hormonal dwarves. This is called andropause. Affectionately termed “man-o-pause,” it is being currently being marketed as “Low T”. Around 40-45 years of age, Prince Charming will begin seeing a gradual decline in his own hormones. He will notice a loss of endurance and loss of muscle mass. He will likely gain some weight around the abdomen, develop insulin resistance, thinning skin, and also diminished interest and desire. Even the uber-macho Prince Charming may experience some difficulty hoisting the sails. In addition, when Prince Charming’s testosterone levels begin to recede, his metabolism shifts into making more estrogen. In his case, it is estrogen, not testosterone, that science demonstrates to be problematic for Prince Charming causing him breast growth and prostate problems.

These inevitable events will result in the decline of hormones putting both Snow White and Prince Charming at increased risk of suffering from a multitude of age-related diseases such as heart disease, osteoporosis, type 2 diabetes, Alzheimer’s dementia and a plethora of cancers such as breast, colon, ovarian and prostate just to mention a few.

So did Snow White stay prim, proper, and fair? Did she truly live happily ever after with her Prince Charming? Or did she become captive by these hormonal dwarves and follow in the footsteps of her contemptuous stepmother?

Had each been around today, they would be pleased to learn there are a variety of both hormonal and non-hormonal therapies that can transform those pesky hormonal dwarves from Itchy, Bitchy, Flashy, Drysey, Bingey, Bluesy and Chubby into:  Happy, Joysey, Energy, Healthy, Slimmy and Sexy! With a good evaluation designed to manage symptoms while preventing illness, both Snow White and her Prince Charming can live not only happily ever after, but happily and healthy ever after to boot.

Note: With any good peri-menopause/menopause or andropause regimen, a thorough workup with your physician is a necessity. Benefits versus risks must always be weighed when starting any therapy whether it be hormonal, herbal or other. Consideration must be given to each person’s goals and aspirations coupled with risk factors and routine screenings such as annual exams, bloodwork, mammogram, dexa bone scan and colonoscopy in order to achieve optimal health outcomes.

Dr. Lemley is the only physician in SW Montana who carries the Certified Menopause Credential from the prestigious North American Menopause Society (menopause.org). He has practiced for 11 years in the Gallatin Valley and can be found at Bridger Natural Medicine Clinic, 2419 W. Main, Suite 1, Bozeman, MT  59718.  Ph:  406-585-0205. Menopause/hormonal questions for this forum may be emailed directly to Dr. Lemley at:  BridgerND@gmail.com