Anne here. When I first met Susie, a retired 63 year-old, she had been experiencing an average of 8 hot flashes during the day and 4 episodes of night sweats, where she would be fully drenched in sweat. It had been going on for ten years. She had been in menopause for thirteen years and had been suffering the entire time.
Susie hates taking medications and her naturopath had tried all the typical herbal menopausal supplements – dong quai, black cohosh, and wild yam – and none of them had any effect on her temperature fluctuations. Susie was understandably frustrated and exhausted – the night sweats woke her up each and every time and she’d need to get up, splash her face with water, and change her nightgown. She couldn’t remember the last time she’d had a full night’s rest.
Of course, no one had done any hormone testing with Susie and that’s the first thing I suggested. When her results came in, I sat down with her and explained what was really going on.
First of all, we were both surprised to see that her estrogens and progesterone were fairly well-balanced for a woman experiencing the number and severity of sweats she was having. The real reason for Susie’s hot flashes weren’t because of a sex hormone imbalance – it was primarily due to her severely dysregulated adrenal function.
No one had ever explained to Susie that when the ovaries stop producing estrogen and progesterone, the adrenal glands are supposed to take over. While the adrenals can’t secrete the pre-menopause level of hormones the ovaries once did, they are designed to fill in the gap post-menopause.
Susie’s cortisol was flatlined. Her DHEA was in the toilet. The signaling from her brain to her adrenal glands was impaired and her poor adrenals were struggling to cope. Prior to retirement, Susie had been a high-powered executive and a single mom. Once she hit menopause, the lack of sleep had further denigrated her adrenal function, creating a vicious cycle of stress and exhaustion.
With clients like this, they first and foremost need our compassion – life is miserable in this type of hormonal storm. They also require our skill and expertise to dig deep into what’s really going on – the true mechanism of dysfunction – and support it at a root-cause level.
Once we recognized Susie’s real issue, we were able to support her appropriately and within three months, everything quieted down – no more hot flashes or night sweats and she’s thrilled to be sleeping a solid 7-8 hours every night.
We all have a Susie in our practice and each of them will present differently. Our work is to identify biochemical weaknesses in each of them and support accordingly.
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FAQ
The following frequently asked questions expand on the key clinical concepts discussed in this article and provide additional context for practitioners supporting clients with menopausal symptoms.
Who may benefit from a root-cause evaluation for persistent hot flashes and night sweats?
Clients with persistent or severe menopausal symptoms may benefit from a root-cause evaluation rather than symptom-based treatment alone. As illustrated in this case, long-standing hot flashes and night sweats may reflect underlying physiological dysfunction that requires further investigation.
Are hot flashes always caused by estrogen or progesterone imbalance?
No. This case demonstrates that severe hot flashes and night sweats may occur even when estrogen and progesterone appear relatively well balanced. Practitioners should consider additional physiological systems when evaluating menopausal symptoms.
Why is hormone testing important for clients with persistent menopausal symptoms?
Hormone testing can help identify the underlying mechanisms contributing to symptoms rather than relying on assumptions. In this case, testing revealed that adrenal dysfunction, rather than sex hormone imbalance, was the primary contributor.
What role do the adrenal glands play after menopause?
According to this article, the adrenal glands are designed to help fill the hormonal gap after the ovaries stop producing estrogen and progesterone. Although they cannot produce pre-menopausal hormone levels, healthy adrenal function remains an important part of post-menopausal physiology.
How can adrenal dysfunction contribute to hot flashes and night sweats?
This case suggests that severely dysregulated adrenal function may contribute to persistent vasomotor symptoms. The client’s flat cortisol pattern, very low DHEA, and impaired brain-to-adrenal signaling were identified as key contributors.
What clinical findings suggested adrenal dysfunction in this case?
Several findings pointed toward impaired adrenal function rather than a primary sex hormone imbalance.
- Flatlined cortisol
- Very low DHEA
- Impaired signaling between the brain and adrenal glands
- Long history of stress and poor sleep
How can chronic stress and poor sleep affect adrenal function during menopause?
The article describes chronic stress and sleep disruption as factors that may further impair adrenal function. In this case, years of occupational stress followed by ongoing sleep loss from night sweats created a cycle of stress and exhaustion.
Why is identifying the true mechanism of dysfunction important in menopause care?
Identifying the underlying mechanism allows practitioners to provide more targeted support. In this case, recognizing adrenal dysfunction changed the clinical focus and was followed by significant symptom improvement.
How should practitioners approach clients experiencing severe menopausal symptoms?
Practitioners should combine compassion with thorough clinical investigation. The article emphasizes understanding each client’s unique biochemical weaknesses instead of assuming all menopausal symptoms have the same cause.
Can addressing root causes improve long-standing hot flashes and night sweats?
This case demonstrates that supporting the identified root cause was associated with meaningful improvement. After three months of appropriately supporting adrenal function, the client’s hot flashes and night sweats resolved and she was sleeping seven to eight hours each night.
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ABOUT THE AUTHOR
Anne Fischer Silva’s journey in the field of functional nutrition over the last 23 years began in a functional medicine practice, where she learned the power of objective testing. From there she opened her own business, A New Leaf Nutrition, where she built a wait-list distance practice. Anne has taught nutrition courses in Washington, Hawaii, and California, and hosted a radio show, “Health-Wise”, for 3 years. She helped develop the original curriculum for the Nutritional Therapy Association, was a lead instructor with NTA for 8 years, and she continues to lecture nationally on a variety of health topics. Anne founded the Institute of Restorative Health in 2013 with the sole purpose of training other nutrition professionals how to address complex issues with their clients and achieve the same stellar results she gets in her practice.
The core principles Anne built the Institute of Restorative Health upon are the importance of nutrient-dense foods and balancing biochemistry. From there, she looks for the deeper underlying issues by utilizing a variety of testing techniques and customized healing methods to restore optimal function and health.
Anne received her certification in functional nutrition from Advanced Integrated Medical Institute in Washington, DC in 2000 and she is a Master Restorative Health Practitioner and Functional Nutritional Therapy Practitioner.
*In 2022, Anne decided to pursue new and different aspects of holistic wellness and left the Institute of Restorative Health in the hands of her dear friend and business partner, Margaret Floyd Barry.
