Menopause

womanCommonly called the “change of life” (the correct term for the period before cessation of menstruation is perimenopause or climacteric), menopause refers to the time in a woman’s life when the ovaries begin to produce smaller amounts of the female hormones, estrogen and progesterone, resulting in physical and emotional changes. Menopause is not a disease or even a dysfunction, but rather a part of the natural aging process. Because it is usually accompanied by uncomfortable “signals,” it is most often looked upon as a problem instead of a process.

Depending on their diet, health, and country of origin, women become menopausal at different ages. Medically, menopause is said to have occurred when the ovaries stop producing eggs and menstruation ceases for at least one year. While this can occur anywhere between the ages of thirty-five and sixty, natural menopause occurs among 50 percent of women between the ages of forty-seven and fifty-two, most frequently between forty-five and fifty-four. Women who smoke generally go through menopause a few years earlier than nonsmokers, as smoking causes a decrease in ovarian estrogen. Early menopause also occurs when both ovaries are removed surgically.

A woman who has undergone a hysterectomy earlier in life, resulting in a stoppage of menstruation, will still experience other symptoms of normal menopause at the usual age. The only difference is that she will not be able to use the absence of monthly periods as a barometer of the change.

At the onset of menopause, alteration in the menstruation cycle varies: it may stop suddenly; the amount of flow each month may gradually decrease over a period of time; or the interval between menstrual periods may lengthen until menstrual flow ceases completely. The average time frame, however, is five to seven years.

During the perimenopausal period (prior to actual menopause), the gradual reduction in estrogen may cause several problems, some of which are immediate and some of which occur postmenopause. Changes can occur in the bladder, causing frequent urination (see chapter 3, “Bladder-Related Problems”). Additionally, the skin loses much of its natural oils, causing skin dryness; the hair also becomes dry and brittle, leading to hair loss. Several areas of the body become more prone to infections during and following menopause (see chapter 3 and chapter 6, “Vaginal Problems”).

Changes in metabolism occurring during menopause lead to problems later in life. The loss of calcium in the bones may result in osteoporosis in later years. Rising blood pressure and increased fats in the blood often lead to atherosclerosis, coronary heart disease, and stroke. Plus, as the metabolism slows down, the ratio of lean-body-mass to fat changes, and fat tends to accumulate on the abdomen, thighs, and breasts.

Menopause is not perceived in the same way around the globe. In cultures where elders are revered, such as among Asian, South African, and Arabic populations, menopause is actually looked upon as a positive occurrence. No longer do women have to endure the monthly menstrual cycle, which is considered evil in some societies. No longer do they face the pain of childbirth or the problems of raising children. Now considered respected elders, menopausal woman are consulted for their wisdom and life experience. In many societies, they are even relieved of chores and duties because of their elevated status.

But in American culture, where youth instead of age has become revered, menopause is looked upon by many women as a negative life change. Many women feel they are “put out to pasture” by society and no longer have their youthful vibrancy and attractiveness.

Interestingly, researchers have discovered that meno-pausal women in age-positive cultures experience fewer problems with menopause. While different diets account for some of the symptom variances, experts in the field credit the more positive outlook toward menopause for most of the differences.

Recent trends are profoundly affecting the attitudes of Americans toward menopause, and thus toward its treatment. The major change is an increase in attention to and education on the subject, as 76 million well-read baby boomers cross the threshold into perimenopausal territory. As baby boomers learn about the subject, attitudes continue to change; no longer is the topic discussed in hushed tones and behind closed doors.

HOT FLASHES AND OTHER SYMPTOMS

Hot flashes are the most reported problem associated with menopause, affecting 50 to 85 percent of women. These can vary in severity from a low-grade warm flush enveloping the body to heavy sweating. They may last a few moments or for several minutes, and they may occur infrequently or many times each day. Most often, they last a few minutes, occur several times a day, and continue for two to five years. While they are at least an annoyance and frequently a nuisance, fewer than 40 percent of women suffer enough distress to seek medical attention due to mild hot flashes alone.

For some women, hot flashes occur at night as night sweats, disturbing their sleep patterns—sometimes frequently enough to cause severe energy loss, mood swings, irritability, headaches, and lack of concentration. Hot flashes give no warning; they occur unexpectedly, sometimes at the most inopportune moments, causing embarrassment when the skin reddens due to increased blood flow. Some women find that overeating, alcohol, stress, or exercise can activate hot flashes. Other hot flash stimulators include caffeine, spicy foods, sugar, drugs, and hot temperatures. Eating smaller amounts at more frequent intervals will usually help curtail hot flashes.

Traditional Treatments

Because 80 percent of women’s hot flashes fall into the uncomfortable or nuisance category, medical treatment is not usually necessary. If this statement describes your flashes, simply try wearing natural fabrics such as cotton or wool, which may help you stay drier and more comfortable when symptoms occur. If you frequently experience hot flashes while away from home, such as while on the job, keep cold packs handy; you can place them against your forehead, face, and wrists to counteract the warm cocoon enveloping you.

If, however, your hot flashes are so frequent or intense that you are losing sleep or experiencing other serious problems such as dizziness or heart palpitations, you may want to consider medical treatment.

Hormone Therapy A common treatment for hot flashes and other physical problems associated with menopause, hormone therapy involves replacing depleted estrogen in a woman’s body. The two options are estrogen replacement therapy and hormone replacement therapy; the latter involves a combination of estrogen and the hormone progestin (a synthetic version of the natural hormone progesterone). Most physicians prefer the combination, since estrogen alone increases the chance of cancer of the endometrium, plus can harm the liver and gallbladder. The progestin has been found in some cases to not only prevent the added estrogen from causing cancer, but to decrease the risk of heart disease, long-term uterine damage, atherosclerosis, and osteoporosis, and other bone deterioration.

When handled properly, hormone therapy can reduce and possibly eliminate hot flashes and other symptoms. Women should be aware, however, of factors that would exclude them from treatment, such as a personal or family history of breast cancer, liver cancer, or endometrial cancer. The negative side effects of progestin may include monthly bleeding or spotting, breast tenderness, mood changes, fluid retention, pelvic cramping, and swelling. It is important to discuss these concerns with your physician from the very beginning; once treatment has begun, be sure to report any side effects right away.

Estrogen can be administered in the form of patches. The Climara patch, introduced in mid-1995, is as thin as a piece of tape and needs to be changed only once a week, compared to earlier estrogen patches that were more rigid and needed to be changed twice as often.

Alternative Treatments

Diet A 1990 study noted that Japanese and Indonesian women have very little incidence of hot flashes, especially compared to American women. Researchers believe this is due to the traditional Oriental diet that incorporates many soybean dishes. Soybeans are high in phytoestrogens (phytohormones with estrogenlike properties) which stimulate the woman’s body to produce more estrogen, if it needs it. (Phytohormones are plant substances that function similarly to human steroids; they have a weak effect on humans.)

Nutritionists have found that the following foods help alleviate or even stop hot flashes:

• whole-grain cereals

• legumes

• fruits

• vegetables, especially broccoli

• low-fat protein foods

There are a number of foods that nutritionists say should be avoided as well. These include caffeine, alcohol, dairy products, and sugar, all of which have been known to increase hot flashes and discomfort.

Nutritional Supplements Vitamin E is widely recommended by nutritionists in treating hot flashes because it naturally balances the level of estrogen. If you have low levels of estrogen, vitamin E increases its output—and it miraculously decreases output in women whose levels are high. If you eat a high percentage of refined foods, combined with few whole grains or seeds, you could be shortchanging your body, only providing low levels of natural vitamin E. Natural sources of vitamin E include sunflower seeds, almonds, fish, sweet potatoes, wheat germ, and whole wheat bread. Nutritionists also recommend primrose oil or black currant oil to stimulate the production of estrogen.

To relieve hot flashes, nutritionists recommend starting with a low level of vitamin E (30 to 100 IU), then gradually increasing over several weeks until the frequency or intensity of your hot flashes decrease. While it may take as many as 1,200 IU of vitamin E per day to alleviate your hot flashes, experts suggest not going above 600 IU without first consulting your health care practitioner, taking large amounts of vitamin E over long periods of time can lead to abdominal pain, nausea, and diarrhea. Because vitamin E is fat-soluble, you will assure effectiveness by taking it along with food containing some fat.

Potassium supplements are important if you experience very intense hot flashes with resultant heavy perspiring. Nutritionists suggest a daily intake of 99 mg.

Bioflavenoids taken along with vitamin C strengthen blood vessel walls, which helps them prevent hot flashes. Divided doses—totaling from 500 mg to 2,000 mg per day—are recommended by health care providers, with hesperidin the most recommended. Natural bioflavenoids are present in citrus pulp, grape skins, berries, cherries, leafy vegetables, and wine. Some experts prefer bioflavenoids derived from citrus fruit for menopausal treatment.

Herbalism Ginseng has been used for centuries around the world to correct temperature imbalances such as heat stress and hot flashes. Many forms and sources of ginseng exist; most health care experts agree that the best for regulating hot flashes is American ginseng. Mix it with hot water for a soothing tea; it is most effective when taken on an empty stomach. It may be ineffective if taken along with vitamin C tablets or foods high in vitamin C, which tend to neutralize it.

Vitex, also known as chaste tree or chasteberry, is the primary European herbal treatment for menopause. Taken regularly over several months, it will help control your hot flashes by increasing your natural levels of progesterone. Do not, however, take Vitex if you are on birth control pills. Follow the instructions on the bottle’s label; it may be available in capsule form or as an extract, which you add to juice or water. You will need to take it two months or longer for it to be effective. You may find Vitex already combined with other herbs such as black cohosh, sage, dong quai, gotu kola, wild yam, licorice root, or sarsaparilla. If you have palpitations along with your hot flashes, take motherwort.

Black cohosh is a mild herb that is a source for progesterone and can relieve hot flashes. You may find it under the name squawroot or snakeroot, as it was known by the American Indians, who used it widely in treating “women’s” problems related to menstruation. Try one capsule per day; if necessary, increase to two capsules. Do not take if you are being treated for any type of chronic disease or if you are or are trying to become pregnant.

Dong quai, a source for estrogen, has been the Chinese treatment of choice for hot flashes for centuries. If you notice any extra degree of nervousness while taking it, change to black cohosh.

If you do not have problems with high blood pressure, which licorice can exacerbate, combine licorice root and sarsaparilla. This is a good combination because the licorice is a source of estrogen and the sarsaparilla is a source for progesterone.

Homeopathy Homoeopathic specialists suggest pulsatilla if you have mild flushing in the face, lachesis if you experience sweating, and kreosotum if you suffer intense burning and sweating over the entire body. Sulphur is also a treatment for intense hot flushes extending over the entire body. Other homeopathic remedies for hot flashes include ignatia and mulimen.

Acupuncture Acupuncturists treat hot flashes by applying needles at points in the neck, back, lower trunk, abdomen, upper limb and lower limb, thus affecting the vasomotor nerves.

Aromatherapy Massaging fennel and sage on your abdomen or lower back will help regulate estrogen production. Using a misting bottle, spray yourself with spring water and a few drops of clary sage to cool down your body during hot flashes.

BEHAVIORAL CHANGES

Prior to menopause, sometimes even before the patient has any idea she is perimenopausal, a woman may experience anything from crying spells to periods of depression, often with no apparent reason. For some women, premenstrual syndrome will worsen. Some women also experience irritability, feelings of vulnerability, insomnia, or memory lapses.

Mood swings have been so prevalent in menopausal women, in fact, that menopause has become a convenient scapegoat for every show of emotion by women over the age of forty. But not all bouts of depression are related to menopause, and not all menopausal women experience these behavioral changes.

When depression and mood swings are related to menopause, experts disagree over the causes. Some say they are due to changes in the endocrine system; others argue that the changes are related to social issues, as women in this age group face significant upheavals in their lives during this time frame. Recent studies correlate these changes to already present physical problems, nutritional deficiencies, poor lifestyle habits, stress, insufficient sleep, and unresolved psychological issues.

Traditional Treatments

Estrogen-Androgen Replacement In addition to being effective in relieving irritability, nervousness, and forgetfulness, a combination of estrogen and androgen has also greatly improved sexual functioning among some women who have had early surgical menopause. Since androgen is a male hormone, women should keep in mind that possible side effects include an increase in body hair and a deepening of the voice.

Alternative Treatments

Diet If you are experiencing periods of anxiety, dietary experts recommend eating carbohydrates and proteins to raise serotonin levels in the brain. Especially helpful are breads, cereals, chicken, pasta, nuts, and seeds. While sugar in small amounts will also produce serotonin, too much sugar can bring on feelings of depression. Protein will also release dopamine and norepinephrine, which produce chemicals that stimulate the mind and lead to alertness, counteracting the negative feelings.

Nutritional Supplements Nutritionists believe that B vitamins will help psychological and emotional problems that are linked to menopause, since they help maintain healthy nerves and ease depression or anxiety. Add two tablespoons of wheat germ to your fruit and cereal each day, plus take one B complex supplement a day. For specific behavioral change corrections: Take vitamin B1 (thiamine) for depression, irritability, loss of energy, and inability to concentrate; take vitamin B3 (niacin) or vitamin B6 to fight insomnia, nervousness, and irritability; for more intense feelings of depression or agitation, take vitamin B12.

Other nutrients that various authorities suggest to improve mood irregularities are: folic acid (irritability, apathy); vitamin C (fatigue); vitamin E (depression, lethargy); potassium (nervousness, irritability); calcium (anxiety, fatigue, insomnia); iron (depression, lethargy, poor concentration, irritability); and essential fatty acids (anxiety, insomnia, irritability).

Herbalism Herbalists offer various suggestions based on an individual’s symptoms. To ease feelings of anxiety, take one-half teaspoon of skullcap with chasteberry. Other soothing herbs to calm menopausal stress include passion flower, valerian root, Vitex, Siberian ginseng, dandelion root, garden sage, and herbal teas such as chamomile, catnip, and peppermint.

To energize feelings of fatigue and depression, take herbs high in nutrients such as oat straw, ginger, cayenne pepper, dandelion root, blessed thistle, and Saint John’s-wort.

A primary European treatment for speeding blood flow to the brain and improving thinking is Ginkgo biloba. Studies have shown that 40 mg, taken three times a day, will help relieve depressive moods, poor memory, anxiety, fatigue, confusion, and absent-mindedness.

Passion flower is a natural tranquilizer, relieving anxiety, insomnia, and nervous tension. Mix 14 to 15 drops of extract in liquid and take as needed. Because it may cause drowsiness, do not take it when operating machinery or when driving motor vehicles.

Homeopathy Pulsatilla (wind flower) is known to help women who suffer from mood changes and/or who cry frequently.

Aromatherapy Aromatherapists recommend massaging your abdomen or lower back with rose oil or jasmine oil to lift your spirits out of depression. To alleviate mood swings, add essential oil of bergamot, geranium, rosewood, or clary sage to your bath water.

VAGINAL DRYNESS

Vaginal dryness occurs when the vaginal skin thins and its natural lubricating secretions decrease as estrogen levels fall. Because of this dryness, sexual intercourse often becomes difficult and painful, perhaps even causing bleeding. Vaginal dryness can also lead to an uncomfortable itching or burning sensation.

Traditional Treatments

Estrogen Replacement Therapy This is the most common treatment practiced by doctors (see Hot Flashes, p. 118).

Estrogen Creams Estrogen vaginal cream concentrates its effectiveness in the area where it’s applied, so it is especially effective in countering vaginal dryness or itching. One cautionary note: With creams, estrogen (which may increase the chance of cancer or, in pill form, harm the liver or gallbladder) does penetrate the vaginal wall and enter the bloodstream, but the amount cannot be regulated as closely as estrogen pills. One positive note: Estrogen cream does not harm the liver or gallbladder, as the pill form does.

Lubricating Jelly Doctors recommend lubricating jelly for alleviating the pain associated with intercourse. Do not use oil-based lubricants such as petroleum jelly and baby oil; they can inhibit the body’s own natural lubrication process by coating the vaginal lining. Water-based lubricants provide extra moisture while they themselves lubricate.

Alternative Treatments

Natural Lubricants Almond, coconut, or vitamin E will add moisture to the vagina. Vitamin E is most frequently recommended by alternative specialists; it’s available in either liquid or suppository form. Natural progesterone creams work well for women who cannot tolerate estrogen. Many experts advise limiting progesterone cream use to small amounts during three out of every four weeks over a six-month period, then gradually decreasing use until it ceases within the year.

Diet Dieticians suggest finding foods that encourage your body to produce extra estrogen when it needs it. Foods containing tofu, soybeans, and soy milk all help build estrogen in the female body.

Essential fatty acids (EFAs) lubricate tissues of the body, including the skin, hair, and vagina. If you have been on a strict low-fat diet, you may be not be eating enough essential fatty acids to accomplish this lubrication (the body does not produce them on its own). You can find EFAs in nuts, pumpkin seeds, sesame seeds, sunflower seeds, salmon, trout, and mackerel. You can also take essential oil supplements—such as evening primrose oil, flaxseed oil, black currant oil, and borage oil—in capsule form. If you are diabetic, do not take supplemental fish oils.

To lessen the drying out of vaginal and other tissues, cut out alcohol, caffeine, diuretics, and antihistamines, all of which are drying agents. Instead of coffee, drink plenty of water, at least one to two quarts per day.

Increase your natural intake of vitamin E by eating more asparagus, avocados, beans, brown rice, dried prunes, green leafy vegetables (such as broccoli or spinach), legumes, nuts, peaches, seeds, vegetable oils, wheat germ, and whole grains.

Nutritional Supplements Nutritionists suggest increasing your levels of vitamin E by taking it in capsule form. Begin with 30 IU daily, then gradually increase until you see results. Do not exceed 800 to 1,000 IU. If you are being treated for diabetes or high blood pressure, do not take more than 30 IU daily. It may take more than a month of vitamin E intake to be effective.

Herbalism Herbalists believe that Vitex will help stimulate hormone production, which will assist in lubricating your vaginal tissues. Take one capsule, one to three times per day, prior to eating (so that your stomach is empty).

Another herbal treatment is to take one black cohosh tablet two times a day, increasing if necessary to two, then three in the morning and two in the evening. Within three weeks, go back to one at night and one in the morning.

Other herbs believed to increase vaginal lubrication are Motherwort, dong quai, ginseng, Chinese angelica, romania, peony root, and thoroughwax root.

Aromatherapy Aromatherapists suggest alendula flowers to help combat vaginal dryness.

Homeopathy Homeopathic practitioners suggest Bryonia (wild bryony) for helping to relieve a dry and thinning vagina.

IRREGULAR MENSES

For some women, very little change in the menstrual cycle occurs preceding menopause, with quite normal monthly periods occurring right up until their stoppage at menopause. But for many women, cycle changes can be dramatic, ranging from more frequent periods to skipped periods; from a lessening of menstrual flow to heavy bleeding and clotting; from spotting between monthly periods to months in which it does not occur. Such irregular menopausal bleeding results when ovulation does not occur because less estrogen is being produced by the ovaries. If heavy or continual bleeding continues for longer than a few months, it could be caused by uterine fibroids, polyps, or (rarely) even cancer. If you have any concern, be sure to consult your doctor immediately.

Traditional Treatments

Cyclic Progesterone Progesterones create a more regular monthly period and reduce excessive bleeding. However, the side effects of progesterone—depression, fatigue, bloating, and breast tenderness—discourage some women from using them.

Birth Control Pills A low dosage of birth control pills can control irregular bleeding for healthy nonsmoking women.

Alternative Treatments

Diet Nutritionists recommend various foods, depending on a woman’s symptoms. To replace iron lost through heavy bleeding, eat almonds, beef, clams, egg yolks, liver, oysters, poultry, prune juice, raisins, red meat, shrimp, spinach, and split peas. Also good for heightening iron absorption is the inclusion of citrus fruits and drinking fruit juices with meals.

To normalize blood flow, eat foods containing vitamin A: butter, cantaloupe, carrots, cod liver oil, egg yolk, kidney, liver, papaya, pumpkin, spinach, sweet potatoes, watermelon, and whole milk.

To reduce heavy blood flow, eat foods rich in vitamin B: beans, brewer’s yeast, lean meats, peas, wheat germ, and whole-grain cereals.

Bioflavenoids, which together with vitamin C help reduce bleeding, can be found in soy products, buckwheat, grape skins, cherry skins, and the inner pulpy peel of citrus fruit.

Nutritional Supplements Nutritionists recommend various supplements, depending on a woman’s symptoms. Iron tablets of 100 mg per day have been shown to effectively treat excessive bleeding.

Vitamin C and bioflavenoids will decrease menstrual flow by strengthening capillary walls; start with 1,000 mg of vitamin C and 500 mg of bioflavenoids. If necessary, increase to 4,000 mg of vitamin C and 2,000 mg of bioflavenoids.

Vitamin A (25,000 to 50,000 IU per day) will normalize blood flow. If your periods are very heavy, take a B-complex vitamin tablet containing at least 50 mg of B1, B2, and B6.

Herbalism Herbalists suggest swallowing one capsule of dandelion leaves as many as three times a day to replace iron lost through excessively harsh periods. You can instead mix 10 to 30 drops of liquid dandelion extract with juice or water. Vitex and wild yam root have also been used to slow down heavy bleeding; take one capsule, one to three times per day.

Aromatherapy Aromatherapists recommend essential fatty acids, which can normalize heavy periods. They can be found in borage oil, black currant seed oil, flaxseed oil, and evening primrose oil. Use one to two tablespoons of them daily on salads and vegetables. They are also available in capsule form.

TISSUE ATROPHY

As hormone levels drop off, vaginal tissues begin to shrink and atrophy, and pelvic tissues weaken. If these supporting tissues weaken substantially, as most often happens among women who have had several children, the uterus may drop down into the vagina (known as a prolapse). At times, the bladder or intestines will break through the weakened vaginal lining, causing frequent urination, burning, lack of urinary control, and bowel problems.

Such tissue changes generally occur slowly over time and may not be apparent until many years after menopause.

Traditional Treatments

Estrogen Creams Doctor-prescribed vaginal creams containing estrogen can restore diminishing hormone levels that lead to vaginal atrophy. As estrogen does spread throughout the body and may cause adverse effects, estrogen creams should be used sparingly and only for a short time (see page 119).

Pelvic Floor Exercises Kegel exercises (named for the pioneering California physician, Arnold Kegel) may strengthen supporting tissues. Place two fingers inside your vagina and tighten the muscles around your fingers, hold for a second, then release completely. Repeat this ten times in a row to make up one group of exercises. Add one group of exercises each day, until within a month’s time, you are doing twenty groups of exercises per day.

 from Physicians’ Guides to Healing: Treating Gynecological Conditions by Dr. Alan Pressman, PhD, CCN, DC.

Note: The information on this website is not a substitute for the advice of & treatment by a qualified professional.

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