Functional Medicine and Women’s Health: Interview with Joel Evans, MD Part 2: Menopause & Stress

We sat down with Joel Evans, MD to talk about Functional Medicine options for common women’s health issues. This is the second in a series. 

What kind of options do you suggest for women entering perimenopause to help address discomfort/symptoms?

Perimenopause is a challenging time of life for many women because just as their ovaries are beginning to put them into perimenopause, life stressors hit. They’re dealing with teenagers—and the stressors associated with raising teenagers—they’re applying to college or leaving home; they’re dealing with aging parents that require more attention. There are financial stressors, and all of those stressors can put stress on marriages.

So, there are a lot of challenging life events that coincide exactly with the perimenopausal period. To make matters worse, stress makes all the physical manifestations of perimenopause worse.

We have this hormonal roller coaster taking place at the same time as the occurrence of stressful life events. The first change that we see is a decrease in progesterone in the second half of the cycle. Progesterone has anti-anxiety effects, and progesterone helps with sleep.

The second thing we see is an increase in estrogen levels, which changes the relationship between estrogen and progesterone. Elevated estrogen also causes symptoms like breast tenderness and breast pain, as well as building up the lining of the uterus, which can cause changes in the bleeding pattern in perimenopause. There can be longer intervals between periods, the blood flow can be heavier because the lining is thicker, and more material has to come out during the menstrual flow. There can be sleeplessness, anxiety, and depressed mood.

If a woman has entered perimenopause and is having hot flashes, many times I’ll recommend ERr 731^®. It is a plant-derived ingredient that has been shown in clinical studies to reduce daily hot flashes from 12 to 2 in as little as 12 weeks—an 83% reduction.* Patients have found it can be an effective relief for a wide range of other menopausal symptoms including: sleep disturbances, mood, irritability, and anxiety. I’ve also had great success with chasteberry and black cohosh to help support menstrual regularity, ease menstrual cramps, and support reproductive health. If this is a concern, I’ll also suggest they try ashwagandha, an herb to help support healthy libido.^†

What is the typical relationship between stress and fatigue? What testing do you do, and what are your typical recommendations?

Stress causes hormone imbalance and dysfunction and metabolic abnormalities, and both the metabolic abnormalities and the hormone imbalances create fatigue.

Stress causes imbalances in adrenal function. It will lead to elevated cortisol and ultimately lowered DHEA-S. Cortisol helps the body with metabolism. Elevated cortisol directly causes diminished thyroid function, and when the thyroid is underperforming, hypothyroidism leads to fatigue. Low DHEA-S levels also lead to fatigue. Ultimately, when the body has been producing cortisol for too long, it can’t continue that, so less cortisol is produced, and that leads to fatigue.

I like doing an adrenal stress profile, a 24-hour test of adrenal function with four salivary samples. I see what cortisol is on wakening, during the day, and right before bed.

People who are stressed and wired may have too much cortisol at night, and they can’t sleep. I will recommend taking herbal supplements that contain ingredients like Schisandra, jujube, and Rehmannia root at night to address organs and systems involved in the stress response. Adrenal adaptogens such as Asian (Panax) ginseng, Cordyceps, and Rhodiola work great in the morning to support adrenal function. Many times I’ll also recommend DHEA, which is associated with healthy adrenal function. Pantothenic acid and pyridoxine (vitamins B₅ and B₆) as well as licorice root extract can also help increase cortisol production and decrease cortisol breakdown.^†

Read part 1 of our interview series with Joel Evans, MD.