Hot flushes and night sweats

Hot flushes and night sweats are hallmarks of menopause, occurring in more than 70% of women and can  last up to 10 years after menopause. They emerge as oestrogen and progesterone levels decline, and also good evidence implicates  the involvement of the autonomic nervous system too. 

In this post I’ll address the hormone component and next week the autonomic nervous system. 

The conventional medical mindset is that menopause is an oestrogen deficiency resulting from ovarian failure. While oestrogen levels   decrease during perimenopause, the truth is, levels do not fall appreciably until after a woman’s last period. In fact, far more women suffer from the effects of oestrogen  during the transition — that is, they have too much oestrogen relative to progesterone. 

Oestrogen Dominance Symptoms

I find many women in their late 30’s and then early forties can find that they experience moderate to severe symptoms of oestrogen dominance as they approach perimenopause.

• Decreased sex drive

• Weight gain (particularly around the abdomen and hips)

• Irregular or otherwise abnormal menstrual periods

• Bloating (water retention)

• Breast swelling and tenderness

• Headaches 

• Mood swings (most often irritability and depression)

• Hair loss

• Thyroid dysfunction ( Progesterone and thyroid crosstalk)

• Sluggish metabolism and fatigue

• Foggy thinking, memory loss

• Trouble sleeping

What Causes Oestrogen Dominance

When a woman’s menstrual cycle is normal, oestrogen is the dominant hormone for the first two weeks leading up to ovulation and is balanced by progesterone during the last two weeks.

As a woman enters perimenopause and begins to experience anovulatory cycles (cycles where no ovulation occurs and thus significant release of progesterone), oestrogen is unopposed, causing symptoms. 

Missing  or skipping ovulation is however, only one potential factor in oestrogen dominance. There can be many other causes, including:

• Excess body fat: will generate the production of excess oestrogen. A hormone called aromatase in fat cells converts testosterone into oestrogen, adding to the oestrogen pool

• Xenoestrogens: are substances that are close enough in molecular structure to oestrogen that they can bind to oestrogen receptor sites and add to the oestrogen pool. Sources of Xenoestrogens include plastics, pesticides, chemicals, cosmetics  and water systems.

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• Genetic control of how oestrogen is made and eliminated: 

Oestrogen is made in the primarily in the ovaries and the brain, liver, pancreas, fat cells, intestines, and adrenals. Once the life of an oestrogen molecule is over, the body needs to get rid of it and it travels to your liver where it is metabolised (transformed or changed into a different molecule) and detoxified (made water soluble to be eliminated). The first step in the metabolism of oestrogen is called hydroxylation (for the biochemists in the audience, oxygen is inserted) where it is transformed into one of three break-down molecules to become 2-hydroxy oestrogen, 4-hydroxy oestrogen or 16-hydroxy oestrogen.  In terms of oestrogen dominance if a woman is making more of the 4-hydroxy oestrogen or 16-hydroxy oestrogen,  oestrogen dominance  symptoms will most certainly occur.

The second step of detoxification is termed conjugation, during which these oestrogen metabolites are packaged into water-soluble compounds making the metabolite water soluble so it can be excreted out in the bile, faeces or urine - clever hey!

Now  ALL of these processes are “run” by enzymes that are coded by genes. Any slight nuances in these genes (called SNPs) will impact how a woman both makes  oestrogen metabolites and how they are eliminated…. 

• For example, in the first phase, the genes & enzymes CYP1B1, CYP3A4 or CYP1A1 breaks down oestradiol into respective 2-hydroxy oestrogen, 4-hydroxy oestrogen or 16-hydroxy oestrogen metabolites

• In Phase II, where they need to be made into water-soluble substances the genes COMT, UGT’s and GST’s are involved.

Understanding your own nutrigenomic hormone  profile of how you process and eliminate oestrogen through the liver and GI tract, I firmly believe at this life stage is a must for best helping women co-manage their hot flushes / oestrogen dominance, as all these genes / enzymes can be manipulated through diet and targeted supplementation. For example, if your gene profile indicates a negative impact on the CYP19A1 gene, which is upregulated and produces more oestrogen - I  can “prescribe” inhibitors of this gene expression with the use of green tea, DIM and zinc and lifestyle interventions of lowering inflammation and insulin spikes.  In my clinic I use Lifecode Gx Oestrogen Balance DNA panel. It analyses the genes involved in the oestrogen lifecycle and helps me pinpoint specific nutritional and lifestyle interventions for your genetic make-up.

In closing, there is A LOT we can do through a diet and lifestyle-led approach to lessen the oestrogen pool and support you through this lifestyle and out the other side towards the next exciting stage of womanhood!

As always, in health,

Tanya x