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Welcome to the Healing on Purpose podcast. I’m your host, Dr. Miriam Rahav. The content of this show is meant for informational purposes only and is not intended to diagnose, treat, or cure any illness or health condition. Please discuss all information shared herein with your own personal health authority. I hope you find value in this episode. This podcast is also available on YouTube on the Healing on Purpose channel, should you want to look up any of the graphics, diagrams, or other visuals mentioned in the show. Links to the podcast and its YouTube channel will also be available on my practice website, rahavwellness.com. Please join me on my Facebook group, Healing on Purpose podcast with Dr. Miriam Rahav, to continue this conversation. Enjoy the show.
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Hello and Namaste. I salute the divine within you because the divine is within you. That is why you are here, and that is why we are here together. We are joining right now in a conversation because right now is the perfect time. The time you choose is always the perfect time to step on to, and walk further on the divine path to healing on purpose. On purpose means with intention and with an awareness of what one is doing. In other words, with consciousness. You were made on purpose. You are here with me, and that is no accident. By healing on purpose, you heal so much more than your physical body. You connect to your divine purpose. Healing on purpose is right for you, is right for me and is right for all life. Thank you for consciously choosing healing. Thank you for taking this time for yourself. You deserve it. The world is better when you are healing on purpose. The subject of today’s conversation is menopause. What is menopause? As has become my habit and my joy. In anticipating the conversation, I’ve gone back to the literature just for fun. What I looked at was actually a few books, a few books by some wonderful authors, one of them being a Dr. Physician, medical doctor, who is a obstetrician gynecologist by the name of Jenn Gunther.
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She wrote a book called The Menopause Manifesto that was published in 2021, I believe. I learned, thank you, Dr. Gunther, that the word menopause was conceived in 1812 by a Dr. Charles de Gardein, a French physician. He started with a word called ménépausie, méné being month, and pausie meaning a cessation. Then in 1821, he updated this term to mené Menopause, and then the accent Menopause was dropped somewhere. There was a little accent mark over it. But what is it? Well, technically, it’s when our ovaries, where we have eggs that live in little follicles are no longer… No more follicles, therefore no more ovulation because there are no more eggs. The average age of menopause happens somewhere around to 52 years of age in women. Interestingly, in Christianne Northrup’s book, The Wisdom of Menopause, she mentioned that the average life expectancy of women in 1900 was 40. That menopause has become something of a, relatively speaking, modern phenomena, because we wouldn’t live as women long enough to experience the joy of menopause. There is a little diagram in Dr. Gunder’s book. It’s nice sometimes to have a little diagram. I will share my screen if I figure out how to do that.
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There we go. Here we are. Here we can see a reproductive age, starting from the fancy word for getting our menstrual cycle is monarchy. That age has actually, over time, become earlier and earlier, somewhere around the age 11, 12, 13. Then we talked about the final menstrual period. That’s what this FMP in this schema, if you are looking at this video on YouTube, really not necessary. I’m just mentioning a visual cue for you visual learners out there. Premenopause, which we’ll talk about the time from when hormonal changes might be occurring, which we’ll talk about. Then you are officially postmenopausal if you have one year lapse between your final menstrual period and not getting it again. There might be some menstrual irregularities in the period we call perimenopause, but one year after no period, you are officially crossing the threshold into postmenopause, which is just a new age and a new chapter. What I do want to speak out or speak to, are some things that, as I was reviewing literature, both from Christian Northrup and Dr. Gunder, and maybe a little bit later, if we have some time from John gray, who wrote the book, Men are from Mars, Women are from Venus, and then wrote another wonderful book, Beyond Mars and Venus.
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If we have time to touch upon that, that might be fun. So let’s see how it goes. But what I really wanted to review with you is… Let me just see. I’m going to stop sharing for a minute and cue up another image here and share again and try to teach to an interesting concept and just give a review. All right, here we go. What I want to share with you is actually an image from what is the adrenal gland. The adrenal gland is a gland that sits on top of the kidneys. It might actually be good for me at this juncture to give you, visual learners, just a sense of what it looks like and where it might be located in our body. Let’s find an image relatively showing where the adrenals live inside our anatomy. Just to give you. You can see that they actually live in the back in what’s called the flank. They’re relatively posterior organ. They’re the kidneys. Then you have this little triangular dome on top. That’s the adrenal gland for you visual learners. What I want to show you is actually the events or the hormonal synthetic pathways.
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What is actually being made in this adrenal gland? I will tie it in a bit into why I’m discussing the adrenals when I’m discussing menopause. The adrenals are making so many hormones. They are just a factory for all of these hormones. Now, some of these hormones you may have heard of. We have somewhere in this diagram for you visual learners. If not, remember, that’s totally fine. But you may have heard of a hormone called cortisol. Cortisol is made in the adrenal glands, and it is chiefly made responsible for the stress response, tasked with responding to stress. As such, it tends to get activated quite a bit. By what? Well, By anything. The classic example, if you have heard the fight or flight response, is being chased by a potential predator, the proverb bear or tiger. But really in our modern lived experience, it can be anything. It can be exposure to environmental toxicants, poor diet, lack of sleep, stressful traumatic events, fear, infection, financial woes. I mean, you name it, the adrenal. It lands in the adrenal. Now, The first hormone, that is the precursor, also known as the grandmother, of all the other hormones is what I like to joke and say the most famous hormone you’ve never heard of called If you are looking at the diagram here, pregnenolone is the first step.
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Then pregnenolone can go down two main pathways. By the way, the precursor to pregnenolone is actually cholesterol. The backbone of all of our hormones is cholesterol. We always want to have cholesterol within a reasonable value and not push it down too low because it is the backbone for all of our hormones, amongst many other things as as well as an important structural component of all of our cellular membranes. But I digress. Pregnenolone can then go down a pathway to become testosterone via a few precursors and also estradiol. Another branch of this pathway goes to progesterone, from Pregnenolone to progesterone, and from progesterone to cortisol. Yet another branch of this pathway goes to another famous hormone that many of us have never heard of that’s called Aldosterone. Aldosterone has to do with salt and water balance and also plays a role in blood pressure regulation. Now, the body is trained to prioritize survival above all else. And so, cortisol is the chief product in our challenging modern lives of the adrenals. All the other hormones, while very, very important and serving their own vital physiological roles, may become depleted as the body will sacrifice certain other hormone stores, such as estrogen, such as the male hormones, such as progesterone such as pregnenolone.
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In order to make a stress response, this phenomena is called pregnenolone steal or pregnenolone shunt. That is represented in this image, should you choose to take a look, by a double arrow between pregnant alone. Then what’s nice about this image is that they also made this little dotted arrow red for visual convenience. That is pulled or shunted into cortisol. Another intuitive way that I describe this is if you are, just intuitively think, if you’re under really big stress, if you have had a moment like that, hopefully not, but so many of us can relate to this, are you also in the in the throes of a big acute stress response, also able to eat? Oftentimes, we just can’t eat anything inside the acute stress response. This is an important, how our nervous system gears itself towards stress. The other thing about chronic stress is when we’re in big stress, do we also have a big stress… Sorry, sex What we can see here is that a lot of these hormones, estradiol, DHEA, testosterone, progesterone that are associated with sex hormones, are also produced in the adrenal and can be pulled into, shunted, or sacrificed, in a way, for the survival of our organism, such that when we are under chronic stress, acute and chronic or acute on chronic, any permutation thereof, our sex hormone levels can drop.
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Hopefully, so far, so good. The adrenals make sex hormones as well as stress hormones. When the adrenals are tasked with responding to all kinds of stressors over time, sex hormones can take a dip. Now, when we are relatively young and juicy and have nice, juicy ovaries. Ovaries also make sex hormones, especially estrogen, progesterone, but also some testosterone. In fact, the dysregulation of that is the chief concern in the phenomenon known as polycystic ovarian syndrome, which we have discussed elsewhere. For the purposes of our conversation, I liken the ovaries and their dialog between the adrenals when we are before menopause. As that neighbor that we can always go to when we’re baking cookies and have run short of flour or sugars or eggs and say, Hey, can I borrow a cup of sugar? The ovaries say, Sure, sure, sure, sure. Even if we’re living under stress, we have, as women in our ovaries, a adrenal backup system in the form of hormone synthesis in the ovaries. I really hope you get this. This is a really, really key point. I see this all the time in bloodwork because as it so happens, when I want to get to know someone, of course, their story and their physical exam, but also their labs, and guess what I to look at.
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Surprise, surprise, pregnant alone. Dhea, testosterone, progesterone, estradiol, cortisol. I get a sense of where these things are in cross-reference with a physical exam, with a story, with symptoms, of course. Interestingly, some of my women have gone on and become pregnant, which is a state of big hormone production It has always amazed me to watch simultaneously how when women are pregnant, their adrenals seem to do much better. Forgive me, I’m just doing a little Adrenals seem to do much better, and that is because that backup system, that neighbor who always has the extra sugar, is right there showing up and bolstering those adrenals, conversely, postpartum after women give birth and those huge wave of pregnancy hormones dwindles and the sleeplessness of the nights and the nursing and all the other things kick in, I find that the adrenals can really, really get vulnerable in the postpartum period. That’s something that I’ve also observed very, very much in my community of women who are nursing in the postpartum period, they really, really can experience a lot of adrenal vulnerability. One of the markers that I like to look at for this purpose is that grandmother of all hormones pregnant alone.
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Now, why am I speaking about the adrenals so, so much and mentioning some of these examples from my clinical practice as I speak about menopause? The reason is that in menopause, as our follicles go to sleep, so to speak, or the way I like to say is your ovaries say, Talk to the hand, we’re done. We’re done. Then you have a drop in estrogen, a drop in estrogen. Now, if your adrenals are supported and you have both the psychosocial, the spiritual, the physiological, the nutrition, the supports, and the consciousness, and maybe the medical practice standing alongside you and validating you, bolstering these things as needed, which could be in the form of specific nutraceutical supplementation, such as Pregnant alone itself, such as DHEA, or with helping your body adapt to stress. First of all, recognizing the root cause of stress, which is a deep and nuanced conversation as nuanced as you yourself well, and that I hope on your pathway to healing on purpose, you do find a way to take the time for yourself to step onto that pathway and see where you are Oftentimes, we can hear in your story where you are.
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When we are flexible, when we are resilient, when we have adrenal deserve, we tend to be able to handle stress and handle situations and adapt to change. When our adrenals are vulnerable, you may find yourself being more irritable, being less excited about changes or ventures, initiatives, and so on and so forth. There are a lot of clues that I listen for in someone’s story, including a really, really important one is energy. I also want to mention one thing here vis-a-vis of the pregnant alone, the grandmother of all of our other hormones. It turns out that pregnant alone is concentrated in our brain, and as such, it is neuroprotective, which means pregnanolone protects the brain. Conversely, under chronic stress, our brain also becomes more vulnerable. The reason I think I wanted to mention this is because I wanted to segue, if I may, over to a little section that I cued up from Dr. John Gray’s book, Beyond… Actually, I’m not sure if he’s a doctor. Forgive me if I misspoke. But John Gray’s wonderful book, Beyond Mars and Venus. He writes here about estrogen. Estrogen is from Venus, and that women have turned to estrogen replacement to relieve menopausal symptoms.
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And that there is, I guess he says, right? So I’m just reading from his book. And this is not, by the way, necessarily my opinion. I’m just sharing information that’s out there, and then I’ll speak to this and qualify this a little bit more. Researchers claim that estrogen replacement can not only stop menopausal hot flashes, but also support positive moods, increase energy, and reduce anxiety. Hormone replacement for women has become common because of the harm decreased levels of estrogen can cause. Now, this is a very controversial statement in my book. Decreased estrogen has been linked to osteoporosis, low energy, lack of concentration, mood swings, depression, poor memory, infertility, low libido, and anxiety. What I wanted to do and qualify here was that the drop in estrogen more frequently in my clinical practice relates to that adrenal conversation that we just spent our precious moments together going through. I love what he says down here, which is taking hormones is not always the answer. A worldwide debate is raging today regarding the harmful side effects of taking hormones versus their possible benefits. Indeed, John gray, indeed. While some studies say taking hormones increases the women’s risk of breast cancer, others claim that it can reduce the risk.
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Some experts claim bioidentical hormones which are made from plant chemicals are safer while synthetic or animal-derived hormones are not. What I want to say here is that we are circling around a problem. However, I do not believe we’re really looking at root cause. Because root cause goes back to the adrenals, folks. Because we’re talking about a drop in estrogen, and yes, we see that drop in estrogen. But that drop in estrogen is really exposed perimenopausally because what we’re really exposing, folks, is the adrenals. It’s the adrenals. Because the estrogen that is made in the ovaries as well as the progesterone, as well as the testosterone, can mask to our unstudied eyes who have not delved deeper into hormones, can mask adrenal vulnerabilities can mask the effects of chronic or acute on chronic stress. Usually, it’s the chronic smoldering stress that we might be so accustomed to that we just think that’s the way it is. We don’t have validation out there because, folks, in my world, training in internal medicine as a medical doctor, I was told over and over again, Adrenal fatigue is not a thing. I I sometimes think it’s a little funny to say that because adrenal fatigue is not a thing when you never look at adrenal function.
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If you look at adrenal function and you routinely look at pregnenolone and progesterone and cortisol Cortisol. Some of you who are of the initiated in the world of integrative functional medicine are aware of how cortisol, which is our hormone of stress, also changes depending on time of day. A fancy way of seeing that is cortisol is circadian. It has to do with light and sleep cycles. Me looking at cortisol on bloodwork is not diagnostic. It can be a clue, certainly in the context of a story, in the context of symptoms, in the context of physical exam. Absolutely. However, in and of itself is not diagnostic. Agnostic, if we want to look at a snapshot of the adrenals and their ability to make cortisol in time, we can look at a salivary cortisol curve where we actually have a certain amount of cortisol in our saliva. We can do a spit test within 20 minutes of waking, and then 30 minutes after that, and an hour after that, and midday, and in the evening. We can get a sense of our cortisol curve where we We should be able to, and do in normal circadian patterns, amount of cortisol, which is part of normal waking.
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Traditionally, normal waking would happen often with the sun, with light hitting the back of our eyelids raises cortisol. Similarly, when we are in the dark, cortisol will lower, melatonin production starts. Now we have so many disturbances, so much artificial light and bou light, again, for the initiated This is old hat, but for some of this, this might be new information. These are profound effectors, never mind all of the other things, because anything and everything that can cause us stress, obviously, is affecting the adrenals. I hope this much we have gotten so far. When we look at the adrenals routinely, we, in fact, learn that the adrenals can absolutely be depleted. Before they become completely depleted, which is what we might see in critical care medicine in the hospital, where we cannot mount that stress response, what’s needed to deal with infection. What we saw in my hospital training in critical care in the medical ICU is oftentimes we would give, along with someone struggling to overcome, let’s say, a big pneumonia requiring intubation, would be something called stress dose steroids. That’s cortisone, that’s a big steroid, 100 milligrams, oftentimes every eight hours, to try and just boost those adrenals that have all but given up, and see if then that person can overcome the stress of infection.
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One of the signs that your adrenals may be weak is just waking up tired because you’re not mounting that cortisol that you need in the morning. Then maybe you are tired throughout the day, or maybe you’re actually hyper-reved up. Maybe you’re hyper-reved up because there are things that are stressful. In the beginning, our adaptation to stress is just mount that cortisol, mount that cortisol, mount that cortisol, mount that cortisol. Until what? Until over time, our ability to mount it and mount it and mount it and mount it is depleted. Then we lose a good amount of our estrogen production in our ovaries, and down we go. We’re exhausted, we’re depressed. But remember, this is a complex dance. Just giving estrogen back, which, yes, by the way, estrogen is a hormone that is proliferative, folks. It makes the uterus lining grow big and cushy for egg implantation. It is a growth factor. Our exposure to growth factors from estrogens, including outside estrogens from our environment that are absolutely pervasive. The fancy-schmancy The term for that is xenoestrogen, xenobiotics. In other conversations about endometriosis and polycystic ovarian syndrome in future conversations, our exposure to these xenoestrogens is so staggering.
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We are drowning in a swimming pool of xenoestrogens. If we are experiencing fatigue and irritability and depression and hot flashes, we should be looking to to support the adrenals. We should be looking for other things that might be stressing out our adrenals, blood sugar imbalances, toxicants, infection, life choices. We should, this is an invitation, and this is, I think, where Christian Morthrup steps into this space so beautifully and talks about the wisdom of menopause. She speaks to her own personal story, and it’s so It’s so beautiful. She speaks to how menopause offers us that status shift that can expose the truth of our vulnerability, and that It’s an invitation. It’s an invitation to step into growing a validation, an insight, an inquiry, an examination so that we can get what? We can get conscious about what is pulling our body out of balance, and we can get back on and further on our pathway to be on purpose, on a healing trajectory on a trajectory of knowing ourselves better and better and taking stock. That is really the story that Christiane Northrup tells so beautifully, God bless her forever, in her wonderful the Book, The Wisdom of Menopause.
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If that resonates with you, she really, really is the voice for that. I really welcome you to sit down. It’s a delicious deep dive into that intersection between our physiology and our intuitive wisdom and potentially our spirituality, because we are stepping into this place of holding space for ourselves, which comes from love. It comes from growing into the belief that we deserve that attention. Dr. Gunder really speaks to that saying, It’s time for us to pay more attention to menopause because it’s really a reveal. It’s a reveal of what we’ve been doing. When the body says no, it’s a time to take stock and say, All right, well, why is the body saying no? What is the body saying no to? It’s a time to really compile all of those pieces of the puzzle. I really welcome you to step into this possibility to know yourself better. Now, I just want to say one thing here quickly before we end our conversation for today. I am putting out a request that if there are topics within this topic and I’m not getting specific here. I’m just giving an overview as far as what’s some specific test, but I do want to mention one specific test, which is the Dutch, it’s the dried urine hormone test, also known as the Dutch, it’s an acronym.
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It’s capable of offering you both the salivary testing for the cortisol curve, but also urinary metabolites of your hormones. The reason that this is incredibly important is before, if you’re feeling bad and you just want your energy and you just want to function, and I really get that. It’s like we have to do what we need to do, we have to live our lives. But before you potentially invite the risks, the potential risks of hormone replacement therapy. Please, please, please, this is my public service announcement. Get a Dutch test. See how your hormones are being metabolized. You can actually learn from a Dutch test how your estrogens are being handled. Specifically, there is a estrogen metabolite, the 4-O-H estradiol, hydroxy estradiol, 4-O-H hydroxy estradiol that is potentially really, really carcinogenic and concerning. If your body is pushing your estrogens already prior to hormone replacement therapy down that pathway, hormone replacement therapy is not for you. The risks definitely outweigh the benefits. Before you would consider such a thing, I would love for you to find, acquire, obtain a literacy in adrenal health, look into that. I think that’s an excellent subject for a deeper dive.
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Find someone who can provide a Dutch, or at least go and look on their website. They have information there. I’ve been getting lots of emails from them with wonderful podcasts, so I think that’s a new initiative theirs. I welcome you to look at some of those podcasts and really get empowered and informed on your pathway to being as healing and healed and empowered and on purpose as you can possibly be. And the resources are really out there. Until next time, I hug you and I thank for being with me on this pathway. I look forward to being with you again soon.
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Thanks for listening to the Healing on Purpose podcast today. I hope you found this information helpful, and I encourage you to share this episode with others who may also benefit from the information shared. Please consider rating and reviewing my podcast on Apple Podcasts so more people can find this information. I also invite you to join the Healing on Purpose podcast Facebook group to continue this conversation. I’ll see you there.