MenoPassage – A holistic journey through the menopausal years
Emotional turmoil: the dance of hormones and Serotonin
The menopausal years are often fraught with emotional turmoil, anxiety, depression, irritability, a shorter fuse… and of course we tend to look outward for all the myriad reasons… If we take menopause on as a MenoPassage, a passage into a great new chapter in our lives, we get to look inside a little bit more for the causes of this emotional turmoil.
Most women are aware that menopause is a time of fluctuating hormones, and that may well be the cause of the emotional turmoil. But how does it actually work? Why do the change in hormones affect our moods and perceptions so profoundly? Well, we may want to look a little bit deeper at how the brain works and look at the dance of the hormones with Serotonin, the “happiness molecule”, a major neurotransmitter dictating our sense of wellbeing, our ability to focus and our willingness to explore the world.
Let’s have a closer look at Serotonin for a moment. It fulfills an impressive number of critical roles throughout the body –it promotes feelings of well-being, and arms us against adversity, providing us with resilience. But not only does it affect the emotions, it also regulates appetite, temperature, energy balance, platelet coagulation, bone remodeling, sleep cycles, the inflammatory response and our libido, just to name a few . To make all these processes happen, serotonin works in a dynamic equilibrium relying on communication from other molecules – most notably enter the hormonal players: estradiol and testosterone, as well as the stress hormone cortisol, as well as many others including Vitamin D. Indeed, hormones play a very important role in modulating serotonin signaling.
When we look at Serotonin levels, we need to also look at
- how it is made and what boosts its production,
- how it is broken down and what boosts the breakdown
We will see that it is made from the precursor Tryptopahn, via 5HTP… both substances you can ingest as a supplement… and this pathway is vastly enhanced by estradiol…
Estradiol enhances the production of serotonin and suppresses the enzyme that breaks it down, MAO A, thus extending the longevity of the neurotransmitter. Thus Estrogen is a GREAT SUPPORT for SEROTONIN
This relationship between estradiol and serotonin becomes a lot more evident in perimenopause, when estradiol levels eventually plummet, leaving serotonin somewhat unsupported. This does make a case for potential hormone replacement as a remedy, as it represents one way to support continued high levels of Serotonin. However, now that we understand this, we may be able to look at a variety of other ways of accomplishing the same.
The serotonin system relies heavily on estradiol from the onset of puberty and beyond. This mechanism may also surface in the postpartum period because again estrogen levels suddenly plummet. In circumstances when estradiol levels decrease profoundly, the serotonin system can struggle to adjust. Loss of equilibrium in the serotonin system can then manifest as mood disorders.
Let’s have a look at another player: Testosterone
Testosterone may actually lower Serotonin! Its influence on the brain is finally getting much needed research attention.
But this is where the old-fashioned dualism of the line dividing androgens (testosterone) and estrogens becomes blurry and not well-defined. Many of testosterone’s effects on the brain are paradoxically estrogenic in nature. This is because testosterone also gives rise to estrogen, which in turn supports Serotonin, as we have seen above. Thus it steps on the brakes and the accelerator at the same time, the net effect is more blurred.
Now enters another key player: CORTISOL, the “stress hormone”
And here we find an unexpected kinship between Cortisol and Serotonin
Stress is one of the primary risk factors for developing mood pathologies. When threats are chronic, unrelenting and intense in nature, vulnerable individuals respond by overactivating the production of cortisol, creating a stress cascade that can become a wrecking crew. High Cortisol levels may well engender diminished serotonin levels, because cortisol is yet another substance that promotes the breakdown of Serotonin.
Yet the plot thickens even more when Serotonin emerges not merely as an innocent passive bystander: it can itself promote the production and outpour of Cortisol, thus contributing to its own demise! This in turn can cause insomnia, depression, anxiety and panic disorders.
Ah, and there is one more player: Vitamin D
With respect to serotonin, adequate vitamin D levels are essential for appropriate serotonin biosynthesis. This is probably the one player in the whole drama that is easiest to influence to optimize Serotonin levels.
Now that we understand the territory, we can look at a variety of ways of supporting the serotonin system throughout the menopausal years:
- Support Serotonin production by increasing intake of 5-HTP and/or L Tryptophan. Unfortunately, eating more turkey and bananas, as is purported sometimes, does not seem to be effective, you may actually need to rach for the supplement bottle.
- Support the Serotonin system by practicing mindfulness and meditation as well cultivating positive attitudes and response. Seek out pleasurable and fulfilling experiences.
- Seek exposure to bright light (3000 lux), or even better, sunlight, this has been shown to definitely enhance Serotonin production.
- Exercise, preferably vigorously, at least 3 times/week.
- Consider phytoestrogen or bioidentical estrogen supplementation
- Examine the contribution of Testosterone
- Stress reduction is absolutely essential. It may be beneficial to get an adrenocortex hormone profile (24hrs urine test) to evaluate your Cortisol levels upon awakening and throughout the day. If they are high, this can be adjusted with life style modification as well as an herbal regimen, such as ashwagandha and other adaptogens.
- Acupuncture and Chinese herbs can definitely support this system, as we will explain in a future blog, you may wish to consult with a knowledgeable practitioner.
- Make sure your VitD level is optimal, in my clinical practice, I like levels close to 60 ng
We now have a better understanding of how our hormones interact with our neurotransmitters. By shedding light on this process, we can make adjustments that can alleviate the burden of menopause and allow us to journey through MenoPassage with greater strength and confidence.
by Angela Ingendaay, MD