Nutritional management of surgically induced menopause

A report describes a case of a 32-year-old White female who presented with a history of hormonal imbalance, including stage IV endometriosis, fibroids, infertility, painful and heavy menstrual cycles, and premenstrual syndrome (PMS), and was looking for nutritional counseling. 

Her primary concerns were hot flashes, night sweats, mood changes, and anxiety. She was concerned about long-term bone health due to early menopause. She had four surgeries for endometriosis and fibroids and underwent in vitro fertilization (IVF) two times before successfully carrying out a pregnancy, resulting in twin girls. After childbirth, she underwent surgery for endometriosis with a hysterectomy and oophorectomy at age 30. She received hormone replacement therapy (Premarin) following the procedure and reported feeling "great for six months." Unfortunately, beyond that, the patient began experiencing mood changes, including generalized sadness and anxiety, and becoming short-tempered and angry. She also documented experiencing frequent and intense hot flashes disrupting her work and sleep, for which her Premarin dose was increased to 0.9mg daily. By the time of the initial consultation with the nutritionist, the patient had reduced her Premarin dosage to twice weekly as she didn't feel any relief in symptoms. 

The patient also reported having environmental allergies, frequent colds, and chemical exposure while working as a hairdresser. 

At the Initial consultation, the patient received an assessment regarding nutritional intake forms, Medical Screening Questionnaire (MSQ), and Greene Climacteric Scale (GCS), following which she received an advised to begin a comprehensive nutritional intervention including the Institute for Functional Medicine (IFM) Detox Food Plan, targeted supplements including Lepidium peruvianum, a multi-vitamin-mineral/bone support supplement, fish oil, N-acetylcysteine (NAC), and lifestyle modifications. 

 3weeks after the initial consultation, the patient reported several improvements, including sleeping more soundly and through the night, uninterrupted by night sweats, decreased anxiety (despite increased work stress), and 4-pound weight loss. She also documented having difficulty waking sometimes. Hence her Maca-GO timing was altered to be taken no later than 2:00 p.m. to support feeling more awake in the morning. 

2months following the initial consultation, the patient happily reported complete elimination of hot flashes and marked anxiety reduction. Her increased self-awareness showed the need to eat regularly and sufficiently to support blood sugar and mood regulation. The patient reported 100% compliance with the food plan and supplements and an additional 2 pounds of weight loss without any exercise or stress management protocols.

6months after the initial consultation, the patient remained highly compliant with diet and supplement changes and continued to improve stress management implementation, including exercise. At this consultation, the patient reported 100% resolution of anxiety and hot flashes. She documented suffering from seasonal allergies. Her Lepidium peruvianum dosage was reduced to 1 capsule twice daily for maintenance. However, her multi-vitamin-mineral, bone support, fish oil, and NAC remained unchanged.

Ross K. Nutritional management of surgically induced menopause: A case report. Women's Health Volume.2021;17: 1–5. DOI: 10.1177/17455065211031492.