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DESCRIPTION
Menopause is the permanent cessation of menstruation. This usually occurs as early as age 40 or as late as age 55 and usually spans 1 to 2 years (peri-menopausal symptoms can last longer than 1 or 2 years, depending on the woman). Menopause is normally diagnosed in females after 1 year of absent periods. Menopause is only one event in the "climacteric," a biological change in all body tissue and body systems that occur in both sexes between the mid-40's and mid-60's. Menopause occurring before age 40 is termed premature and may need medical evaluation for the cause.
MENOPAUSE-RELATED PROBLEMS
Menopause, also referred to as the "change of life," is the point at which a woman stops ovulating and menstruation ceases, indicating the end of fertility. When a woman stops ovulating, her ovaries largely stop producing the hormones estrogen and progesterone. Estrogen is commonly though of as a sex hormone tied to reproduction, but it also acts on many different organs in the body. Cells in the vagina, bladder, breasts, skin, bones, arteries, heart, liver, and brain all contain estrogen receptors for normal cell function. Estrogen is needed to keep the skin smooth and moist, the body's internal thermostat operating properly, and the arteries unclogged, for example. It also necessary for proper bone formation.
Although estrogen levels drop sharply after menopause, the hormone does not disappear entirely. Other organs take over from the ovaries and continue to produce some estrogen and other hormones. The organs known as endocrine glands secrete hormones to maintain proper bodily functions. The adrenal glands (small organs on top of each kidney) continue to make estrogens, as does fat tissue. But the ovaries have produced the greatest share of the body's estrogens for decades, and when they quit, the blood levels of estrogens drop dramatically.
The menopausal period is different for each individual woman. Some start earlier and some later, but the average age at menopause is about fifty. The transition (peri-menopause) can take any where from a few years to an average of about 5 years. Some women have peri-menopausal symptoms for 10 years or longer before menopause finally occurs. A woman who undergoes a hysterectomy but who keeps at least one of her ovaries stops menstruating after surgery, but she will still go through menopause. If the ovaries are removed during hysterectomy, menopause occurs suddenly, and symptoms may be more severe.
Some women go through menopause with few or noticeable symptoms. However, many women experience short-term or acute symptoms such as hot flashes, night sweats, mood swings, fatigue, dizziness, headaches, anxiety, depression, poor libido, bladder problems, vaginal dryness and itching, burning and discomfort during sexual intercourse, breast tenderness, dryness and aging of the skin, shortness of breath, heart palpitations, and insomnia. All of these symptoms are due to estrogen and progesterone deficiency. Over the long term, the diminished supply of estrogen increases the likelihood of cardiovascular disease, osteoporosis, and vaginal atrophy. Osteoporosis in particular is a major problem for women after menopause. An estimated 80 percent of the 250,000 hip fractures that occur in the United States every year are due to osteoporosis.
It is important to remember that menopause is not a disease. It is a natural process in a woman's life. How a woman views this time of her life can have a lot to do with how frequent and severe her symptoms are. If menopause is viewed as the end of youth and sexuality, this time will be much more difficult than if it is viewed as the next, natural phase of life. With a proper diet, nutritional supplements, and exercise, most of the unpleasant side effects of menopause can be minimized, if not eliminated.
FREQUENT SIGNS & SYMPTOMS
Physical changes (directly associated with decreased blood levels of female hormones):
- Menstrual irregularity. Sometimes a peri-menopausal woman will experience more than one menstrual period in a month, sometimes she will skip it altogether for a few months before she experiences her next cycle. Some women will experience "menstrual flooding", which is similar to having your period "all at once" with a gushing of blood during the period, often soaking through pads, tampons, and clothing. Periods may change in duration from light spotting for a day or two to lasting for several days longer than normal. There may be more problems with large blood clots being passed during the menstrual period.
- Hot flashes or flushes (power surges) -- sensations of heat spreading from the waist or chest toward the neck, face and upper arms (symptoms are often referred to as vasomotor instability).
- Headaches.
- Dizziness.
- Rapid or irregular heartbeat.
- Vaginal itching, burning or discomfort during intercourse, beginning a few years after menopause.
- Bloating in the upper abdomen.
- Bladder irritability.
- Breast tenderness.
Emotional changes (associated with lower hormone levels and possible conflicting feelings about aging and loss of fertility) often occurs during menopause. Hormone shifts can affect moods. To the extent that these shifts are smoothed out by dietary steps, psychological effects are more manageable. Here are the most common psychological accompaniments of menopause:
- Mood changes. This includes feelings of anger or rage surfacing during unexpected moments, crying, irritability, and so forth.
It is like having really bad PMS... I have experienced a full range of emotions from laughing to crying to rage in a matter of seconds, usually at very inappropriate times or situations. I can sing songs to myself at a funeral of a good friend, I cry at bank commercials on TV, and then can look at an irritating employer or partner and literally visualize his or her head exploding complete with brain tissue and blood gushing on white walls, and then calmly thinking that it would be a beautiful thing glistening in the sunlight. I have found I have "emotional buttons" that I didn't realize I had, until something or someone "pushes my buttons" and sets it off. The extent of the rage that comes out is very scary to me... A menopausal woman in her 50's.
- Pronounced tension and anxiety. Women who have never had a problem with anxiety before may become more self-conscious and more worried about minor events. In some cases, panic attacks occur. Mental health professionals have a variety of effective treatments. Many people feel much better just knowing what the condition is. The most important piece of advice is not to let anxiety restrict your activities. When anxiety or panic disorders cause people to avoid stressful situations, the result can be an ever-tightening leash that keeps them from enjoying life. Anxiety can lead to avoidance of many aspects of normal life. Prompt treatment prevents this.
- Sleeping difficulty. This may include not being able to fall asleep or stay asleep.
- Depression or melancholy and fatigue. Depression seems to be particularly common when menopause is medically induced, e.g., after removal of the uterus and ovaries because of illness. Irritability is also common.
To the extent that depression, irritability, or anxiety need treatment, it is important to explore the full range of available options. The first step is to get your diet in order and to get regular exercise to help stabilize hormone shifts and reduce physical symptoms that can aggravate mood problems. Psychotherapy can be very useful, and new short-term techniques have demonstrated their effectiveness at considerably less investment than is demanded by traditional therapies. New anti-depressants and anti-anxiety drugs have emerged in the past years which have fewer side effects than older medications.
- Minor mental confusion and loss of short term memory episodes. Some women find that menopause brings occasional memory lapses, often related to reduced ability to concentrate. This can be upsetting and annoying, but happily it seems to go away on its own with time.
My women friends and I call this "having a senior moment" or a "menopausal moment" when we lose track of what we are doing or can't remember something that we should, like our phone number or even our name or the name of our partner or a good friend...it is very frustrating, and, yes, annoying to say the least...
CAUSES
A normal decline in ovary function, resulting in decreased levels of the female hormones, estrogen and progesterone.
Surgical removal of both ovaries. See Hysterectomy Related Problems For more information.
RISK INCREASES WITH
Menopause is a natural part of the aging process for women. Smoking is a risk for premature menopause.
If a woman has hypoglycemia, her symptoms often become more pronounced during menopause. Stress puts a burden on the adrenal glands, causing them to work harder than they should. The adrenals therefore produce smaller amounts of the hormones that are needed to help reduce the effects of declining estrogen in the body.
Hypothyroidism is common in menopausal women. Many symptoms ascribed to menopause may be due to improper thyroid function. See Hypothyroidism for more information.
PREVENTIVE MEASURES
Menopause cannot be avoided, but its effects may be controlled or moderated.
Japanese women generally experience far fewer symptoms of menopause than do Western women. An article in the British medical journal The Lancet reported that the reason may be that Japanese women consume more phytoestrogens (plant estrogens). These estrogen-like compounds are found in foods such as soybeans, tofu, miso, flaxseeds, pomegranates, and dates. When these substances are eaten, they act like the estrogens produced in the body.
Keeping or Restoring Strong Healthy Bones
Osteoporosis - thinning of the bone tissue - is common, particularly among Caucasian women, after menopause. The cause is not an inadequate calcium intake, ordinarily. The problem is abnormally rapid calcium loss, aggravated by the following five calcium wasters:
1. Animal protein. When researchers feed animal protein to volunteers and then test their urine a little later, it is loaded with calcium, which comes from their bones. Here's why. A protein molecule is like a string of beads, and each "bead" is an amino acid. When protein is digested, these "beads" come apart and pass into the blood, making the blood slightly acidic. In the process of neutralizing that acidity, calcium is pulled from the bones. It ends up being lost in the urine. A recent report in the American Journal of Clinical Nutrition showed that when research subjects eliminated meats, cheese, and eggs from their diets, they cut their urinary calcium losses in half. Switching from beef to chicken or fish does not help, because these products have as much animal protein as beef, or even a bit more.
2. Sodium (salt). If you throw salt on a slippery sidewalk, it dissolves the ice; if you sprinkle it on your food, it can dissolve your bones, albeit by a different mechanism. Salt apparently increases calcium losses via the kidneys. For an average person, cutting sodium intake in half reduces the daily calcium requirement by about 160 milligrams. Grains, vegetables, fruits, and beans are very low in sodium unless salt is added to them. Snack foods, canned foods, dairy products, and meat tend to drive up the amount of sodium in the diet.
3. Caffeine. Whether it comes in coffee, tea, or colas, caffeine is a weak diuretic that causes calcium loss via the kidneys.
4. Tobacco. Long-term smokers have 10 percent weaker bones and a 40 percent higher risk of fracture.
5. Sedentary lifestyle. Bones that have nothing to do lose their strength.
Healthy Calcium Sources
When you eliminate these calcium-wasters, you need less calcium in your diet. However, you will always need some calcium. If you get very little calcium, say, less than 400 milligrams per day, you may not be giving your body the calcium it needs.
Although many people try to get their calcium from milk, only about 30 percent of calcium in dairy products is absorbed. The remaining 70 percent never makes it past the intestinal wall and is simply excreted with the feces. Milk products also contain lactose sugar, animal proteins, and frequent traces of antibiotics and other contaminants.
The healthiest calcium sources are "greens and beans." Green leafy vegetables are loaded with calcium. One cup of broccoli has 178 milligrams of calcium. What's more, the calcium in broccoli and most other green leafy vegetables is more absorbable than the calcium in milk. An exception is spinach, which tends to keep its calcium to itself. Beans, lentils, and other legumes are also loaded with calcium. If you make green vegetables and beans regular parts of your diet, you'll get two excellent sources of calcium.
You don't need to eat six cups of broccoli or huge servings of beans to get enough calcium. A varied menu of vegetables and legumes can easily give you all you need, and the amount your body needs is far less when you steer clear of meats and the other calcium-depleters. The World Health Organization recommends a daily calcium intake of just 400 to 500 milligrams per day.
If you decide to add extra calcium, calcium-fortified orange juice is a good choice. It contains more calcium than milk, and it is in the form of calcium citrate, which is much more readily absorbed than that in milk or in calcium carbonate supplements.
HEALTHFUL CALCIUM SOURCES
(content in milligrams)Source Amount
Black turtle beans (1 cup, boiled) 103
Broccoli (1 cup, boiled) 178
Brussels sprouts (8 sprouts) 56
Butternut squash (1 cup, boiled) 84
Celery (1 cup, boiled) 54
Chick peas (1 cup, canned) 78
Collards (1 cup, boiled) 148
Corn bread (1 2-ounce piece) 133
English muffin
92 Figs, dried (10 medium) 269 Great northern beans (1 cup, boiled) 121 Green beans (1 cup, boiled) 58 Kale (1 cup, boiled) 94 Kidney beans (1 cup, boiled)
50 Lentils (1 cup, boiled) 37 Lima beans (1 cup, boiled)
52 Navel orange (1 medium) 56 Navy beans (1 cup, boiled) 158 Onions (1 cup, boiled) 58 Orange juice, calcium-fortified (1 cup) 300* Pancake mix (1/4 cup, 3 pancakes) 140 Pinto beans (1 cup, boiled) 82 Raisins (2/3 cup) 53 Soybeans (1 cup, boiled) 175 Sweet potato (1 cup, boiled) 70 Tofu (1/2 cup) 258 Vegetarian baked beans (1 cup) 128 Wax beans (1 cup, canned) 174 Wheat flour, calcium enriched (1 cup) 238 White beans (1 cup, boiled) 161 Source: J.A.T. Pennington, Bowes and Church's Food Values of Portions Commonly Used. (New York: Harper and Row, 1989.) * package information
Sunlight
As sunlight touches the skin, it turns on the natural production of vitamin D, which helps your digestive tract absorb calcium from foods and makes your kidneys hold onto it as well. For those who get infrequent sun exposure, any common multivitamin containing 5 micrograms (200 IU), taken daily, provides adequate vitamin D. For people who never go outdoors due to chronic illness, 10 micrograms (400 IU) is recommended. Higher doses of vitamin D can be toxic and should be avoided.
Restoring Strength to Bones
Natural progesterone stimulates the bones to rebuild healthy bone tissue in areas where it has been lost. Unlike estrogens, it has no known serious side effects. In a study of 100 post-menopausal women, the average patient had a 15 percent increase in bone density after three years of treatment. What makes this so remarkable is that health care providers have been looking for ways to slow the rate of bone loss, and most never dreamed it would be possible to actually build bone. But an increasing number of clinicians are finding exactly that.
Altered forms of progesterone, called progestins (e.g., Provera), are heavily promoted by drug companies and are commonly prescribed by health care providers. But these unnatural chemicals do not quite fit into the body's systems for using and eliminating progesterone. They are the biological equivalent of using the wrong replacement part in your car's engine. While the pharmaceutical companies' financial machinery hums along just fine, your biological machinery can have a multitude of side effects, ranging from facial hair growth and depression to heart disease, liver problems, and even breast cancer. The body was built to use natural progesterone, not inexact copies.
Here is how natural progesterone is used: Usually, a two-ounce jar is used up each month. Later, the dosage may be reduced to one ounce per month. In post-menopausal women, the cream is usually used each month for two to three weeks, then stopped until the beginning of the next month. In women who have not yet stopped menstruating, the cream is usually used from about day 13 to day 26 of the menstrual cycle. To maintain its effect, it is discontinued for at least five to seven days each month.
It is spread on areas of thin skin, such as the insides of the arms or legs, the neck, upper chest, and abdomen, covering as wide an area as possible and varying the areas to which it is applied. It takes a while for progesterone to build up in the fat tissue, so it may take two or three months to be effective.
Because progesterone facilitates the effects of thyroid hormone, women taking thyroid medications may need to reduce or discontinue their thyroid medications after beginning progesterone, which should be done in consultation with their health care providers.
Post-menopausal women who are taking estrogens are often advised to cut their estrogen dose in half when starting progesterone, because progesterone temporarily increases the body's sensitivity to estrogen. Many women find that they no longer need estrogen at all after a few months using the progesterone cream.
Women who are currently using an artificial progestin, such as Provera, can easily switch to natural progesterone, but should taper off the progestin gradually. A typical regimen would be to cut the progestin dose in half for the first month that progesterone cream is used. In the second month, it should be cut in half again, using it every other day, if necessary. By the third month, the progestin can be safely discontinued.
While prescription estrogens are sometimes used to reduce the risk of heart disease, a combination of a vegetarian diet, daily modest exercise, smoking cessation, and stress reduction is much more effective, and has been shown to actually reverse existing heart disease in 82 percent of patients. And while estrogens increase cancer risk, these healthy lifestyle changes actually reduce the risk of cancer and several other illnesses.
EXPECTED OUTCOME
Menopause is a normal process, not an illness. Most women make an easy transition without crisis.
POSSIBLE COMPLICATIONS
Increased irritability and susceptibility to infection in the urinary tract.
Decreased skin elasticity and vaginal moisture.
Increased risk of hardening of the arteries, heart disease, stroke and osteoporosis after menopause.
Changes in feeling of self-worth.
TREATMENT
GENERAL MEASURES
A NATURAL APPROACH TO MENOPAUSE
Every day, in hundreds of health care provider's offices, the same conversation takes place between women going through menopause and their doctors. The doctor writes out a prescription for estrogen pills or patches, saying they will replace the hormones her body ought to be making. They will cure her hot flashes, slow her bone loss, and reduce her risk of a heart attack. The patient asks if the pills cause cancer. The doctor acknowledges that there is an increased risk of uterine and breast cancer, but argues that the benefits to the heart and bones are worth taking the chance.
Other risks enter into the discussion: strokes, blood clots, and water retention, among others. Women who have seen friends or relatives die of cancer or stroke might not find this very reassuring. They may have menopausal symptoms, and they would like a solution. But they are looking for something safe, that doesn't cause more problems than it solves.
Take heart: there are dietary steps, other lifestyle changes, and natural hormone preparations that can make menopause much more manageable. They are better for your heart and bones than estrogen prescriptions could ever hope to be, and they accomplish these things without the side effects of estrogens.
Premarin is a commonly prescribed estrogen preparation from Wyeth-Ayerst Laboratories. Although doctors sometimes describe it as "natural" for women, it is actually a horse estrogen. On farms in North Dakota and Canada, 75,000 mares are impregnated and then confined from the fourth month through the end of their eleven-month pregnancy so their urine can be gathered in a collection harness called a "pee bag." After they give birth, the mares are reimpregnate. Their foals usually end up as horse meat, and the urine estrogens are packed into pills. The trade name "Premarin" is simply a condensation of the words "pregnant mares' urine" - hardly a natural substance for human beings to swallow. While Premarin contains estradiol and estrone, two types of estrogen which are made in humans, it also contains an enormous amount of equilin, a horse estrogen that never occurs at all in humans.
Estrogen supplements increase the risk of blood clots and can cause high blood pressure, gallstones, vaginal bleeding, nausea, weight gain, breast tenderness, skin discolorations, headaches, and depression. They also increase the risk of uterine and breast cancer and make existing cancers much more aggressive. Women taking estrogen supplements have 30 to 80 percent more breast cancer risk than other women.
If progesterone is added to the regimen, it removes the increased risk of uterine cancer, although it does not counteract the higher risk of breast cancer. Synthetic progestins have side effects of their own, sometimes causing breast tenderness and fluid retention, and making depression worse.
So why are so many health care providers prescribing them? Partly to treat menopausal symptoms. But more of the push for estrogens relates to osteoporosis and heart disease. Happily, there are healthier solutions for both problems.
Psychotherapy or counseling, if emotional changes interfere with personal relationships or work.
Continue to use birth control measures until 12 months after your last menstrual period.
Reduce and avoid stress to your life as much as possible.
If you take estrogen-replacement therapy, have a Pap smear annually or as recommended by your health care provider.
Lifestyle changes may be brought about by menopause. Stay as healthy and happy as you can and live life to the fullest.
Frequent sexual intercourse can help relieve vaginal dryness. If sexual intercourse is painful, try using vitamin E oil or aloe vera gel to lubricate the vagina.
For itching in the vaginal area, use vitamin E cream (with no fragrance added) or open a vitamin E capsule and apply the oil. Natureworks Marigold Ointment from Abkit stops itching almost immediately.
Additional information available from:
- National Institute on Aging Information Center
(800) 222-2225
Website: http://www.nih.gov/health/chip/nia/menop/men1.htm
MEDICATION
Hormone replacement therapy (HRT) or estrogen replacement therapy (ERT) may be suggested by your health care provider to control severe symptoms caused by estrogen deficiency in menopausal and post-menopausal women. Because hormone treatment has benefits as well as some risks, learn all you can about hormone replacement therapy before deciding on treatment. HRT is reported to help prevent osteoporosis and coronary heart disease, as well as bring relief to symptoms of menopause (hot flashes, vaginal dryness). Treatment, once started, must continue to be effective. Financial costs and medical side effects may become a deciding factor.
Hormone Replacement Therapy
Although highly controversial, hormone replacement therapy (HRT) is one option many women consider to help ease themselves through the symptoms of menopause. However, it is up to each woman to give careful consideration to the risks as well as the potential benefits of HRT.
The goal of HRT is to restore a woman's hormonal balance, primarily her estrogen level, to something closer to her normal pre-menopausal state. In addition to relieving temporary pre-menopausal and menopausal symptoms, estrogen replacement therapy appears to be an effective preventive against some of the longer term effects of estrogen deficiency, including osteoporosis and heart disease. However, HRT also has a serious dark side, which includes a possible connection to several forms of cancer. A 1995 report by The New England Journal of Medicine reaffirmed the suspected link between estrogen-replacement therapy and breast cancer, while another alarming report suggested that long-term use of estrogen may increase the risk of ovarian cancer. And results of a recent study, analyzed by physicians at the Robert Breck Brigham Multipurpose Arthritis and Musculoskeletal Disease Center in Boston, Massachusetts, indicate a possible connection between the long-term use of estrogen and lupus, a serious autoimmune disorder.
Ultimately, the decision to use hormone replacement therapy is up to each individual. If you are considering estrogen treatment, it is critical to analyze your medical history while weighing the benefits against the possible risks. It is inadvisable to take estrogen if you have a personal or family history of breast cancer, uterine cancer, or fibroid tumors; if you have cystic breasts diagnosed as "atypical hyperplasia"; or if you suffer from liver or gallbladder disease.
It is also important to understand the difference between natural and synthetic forms of estrogen. Synthetic estrogens are manufactured in laboratories and they are not easily broken down by the body's natural enzymes. Because of this, they tend to accumulate in the body. Synthetic estrogens can also cause metabolic changes in the liver, resulting in an increased incidence of such side effects as high blood pressure, fluid retention, and blood clots. Most natural estrogens, on the other hand, although also produced in laboratories, are chemically identical to the ones produced by the ovaries. One popular type of natural estrogen, equine estrogen (sold under the brand names of EStratab and Premarin), is extracted from the urine of pregnant mares. Generally, it is an effective form of replacement estrogen for menopausal women; however, it is extremely potent and may cause metabolic changes in the liver. Equine estrogen probably should not be used by women who are obese, who smoke cigarettes, or who suffer from high blood pressure, high cholesterol, or varicose veins. The most common truly natural estrogens are estropipate (Ogen) and estradiol (Emcyt, Estrace, Estraderm). These natural estrogens are easily metabolized. Any woman who makes the choice to use HRT should use the safer natural estrogens. It is recommended that if you do decide to take estrogen, you should use the smallest possible dose of oral estrogen and take it every other day, rather than every day.
Recent research suggests that replacing progesterone may be more important than replacing estrogen. A safe way to replace progesterone is to use a natural progesterone cream. This can often provide effective relief of menopausal symptoms, and also stimulate the body's production and regulation of estrogen and other hormones.
Vaginal estrogen creams may help dryness by replenishing estrogen losses that lead to the vaginal dryness.
Hot Flashes: For those women who are considering hormone supplements, some preparations may be safer than others. Estrogens that are commonly prescribed by physicians contain significant amounts of estradiol, which is one of the forms of estrogen that has scientists and many post-menopausal women concerned about cancer risk. A different estrogen, estriol, appears to be safer. The best evidence indicates that estriol does not increase cancer risk. Plant-derived transdermal creams containing estriol and smaller amounts of other estrogens are available without a prescription. The estrogens pass through the skin and enter the blood stream, reducing menopausal symptoms. Creams containing pure estriol must be ordered by health care providers, not because they are more dangerous (they are not), but because the process of concentrating them qualifies them as drugs, rather than natural preparations.
Dr. Hanley finds that a mixture of plant-derived estrogens and progesterone is often helpful. Transdermal creams containing estriol, estradiol, estrone, and natural progesterone are very effective in reducing hot flashes.
Regrettably, less research has been done on the use of estriol, compared to estradiol. Even though there is no evidence of cancer risk with estriol, Dr. Hanley recommends that if any estrogen cream, including estriol, is used, that it be accompanied by progesterone to reduce the risk of uterine cancer, and that it be monitored by a physician so it can be tailored to a woman's individual needs. "Whatever formula is used, it should have some progesterone in it," Dr. Hanley said. "Also, women should cycle their hormones. The cream is used from day 1 to day 26 of the cycle, followed by 4 to 6 days off." If additional natural progesterone is used, it should be added for the final two weeks (days 13 to 26) and stopped together with use of the cream.
Natural progesterone alone helps reduce symptoms for some women. Progesterone and estrogen creams are available from Professional Technical Services (800-648-8211), Women's International Pharmacy (800-279-5708), or Klabin Marketing (800-933-9440).
Natural Solutions for Dryness: At menopause, vaginal blood flow falls. Dryness and irritation can occur, and bacteria infections that pass to the urinary tract are more likely.
What is to be done? First of all, even after the ovaries stop, the adrenal glands and the fat tissue continue to contribute to estrogen production after menopause. In addition, phytoestrogens in plants provide weak estrogen effects. Soy products, such as tofu, tempeh, and miso, contain huge amounts of these natural compounds.
The plant-derived estrogen and progesterone creams described above can be helpful. Used on a regular basis, these creams maintain a moist vaginal lining. They should not be used as a sexual lubricant however, as an older couple learned the hard way. A letter to the editor of the New England Journal of Medicine described a 70-year-old man who developed an enlarging left breast. He went to see his physician who removed the mass. Several months later, the same thing happened on the right side. It suddenly struck him that his wife was using a vaginal estrogen cream, not only twice a week to treat vaginal dryness, but also as a sexual lubricant two or three times per week. As gratified as his doctor may have been to learn that this older couple was still maintaining frequent conjugal bliss, the doctor had to conclude that the estrogen cream had caused the man's breast enlargement. They switched lubricants and his enlarged breast went away. Estrogen cream is a medication, not a lubricant, and it goes through any skin it touches. Many women prefer to avoid hormone creams entirely and use ordinary lubricants or moisturizers instead.
After menopause, a reduction in the amount of the sex hormone estrogen can cause shrinkage of urethral and vaginal membranes, promoting incontinence. There may be a continuous dribbling of urine. Urethral dilation helps stretch a contracted urethra.
FURTHER READING: RECOMMENDED BOOKS
Smart Medicine for Menopause: Hormone Replacement Therapy & Its Natural Alternatives
--By Dr. Sandra Cabot
Natural Hormone Replacement for Women over 45
--By Jonathan V. Wright, John Morgenthaler
New Menopausal Years, The Wise Woman Way: Alternative Approaches for Women 30-90 (Wise Woman Herbal Series, Book 5)
--By Susun S. Weed
Wild Woman's Garden: 7 Radical Weeds for Women Over 40
--By Jillian Van Nostrand, et al.
Where's the Toast? A Woman's Guide to Managing Menopause Naturally
--By Yvonne Lewis
Wellness in Menopause: A Guide to Holistic Healing
--By Marylyn Meek
Holistic Menopause: A New Approach to Midlife Change
--By Judy Hall, Robert Jacobs
Controlling Hormones Naturally: My Journey for Solutions to PMS, Menopause & Osteoporosis With Wild Yam
--By Melinda Bonk, Laura K. Fraser
Taking Charge of the Change: A Holistic Approach to the Three Phases of Menopause
--By Lennie Martin, Pam Jung
Natural Progesterone: The Natural Way to Alleviate Symptoms of Menopause, PMS, Endometriosis & Other Hormone-Related Problems
--By Anna Rushton, Shirley A. Bond
The Soy Solution for Menopause: The Estrogen Alternative
--By Machelle M. Seibel, Mark Blumenthal
Get Off the Menopause Roller Coaster: Natural Solutions for Mood Swings, Hot Flashes, Fatigue, Anxiety, Depression, and Other Symptoms
--By Shari Lieberman, PhD
ACTIVITY
No restrictions. Active exercise is beneficial. Weight bearing activities (such as walking) are helpful in maintaining bone strength. Get regular moderate exercise.
DIET
There Is No Japanese Word for Hot Flashes
It has long been known that menopause is much easier for Asian women than it is for most Westerners. In a 1983 study, hot flashes were reported by only about 10 percent of Japanese women at menopause, compared to about two-thirds of women in America and other Western countries. And bone strength is not assaulted to the extent it often is among Western women. Broken hips and spinal fractures are much less common.
The most likely explanation is this: throughout their lives, Western women consume much more meat and about four times as much fat as do women on Asian rice-based diets, and only one-quarter to one-half the fiber. For reasons that have never been completely clear, a high-fat, low-fiber diet causes a rise in estrogen levels. Women on higher-fat diets have measurably more estrogen activity than do those on low-fat diets. At menopause, the ovaries' production of estrogen comes to a halt. Those women who had been on high-fat diets then have a violent drop in estrogen levels. Asian women have lower levels of estrogen both before and after menopause, and the drop appears to be less dramatic. The resulting symptoms are much milder or even non-existent.
More evidence of the diet link comes from a fascinating study by a medical anthropologist from the University of California who interviewed Greek and Mayan women about their experience of menopause.
The Greek women were subsistence farmers. Menopause occurred at an average age of 47, compared to over 50 in the United States. About three-quarters had hot flashes, but they were considered normal events, however, and did not cause women to seek medical treatment.
The Mayan women lived in the southeastern part of Yucatan, Mexico. Menopause occurred earlier than in Greece or North America, at an average age of 42. Unlike the experience of Greeks and Americans, hot flashes were totally unknown among Mayans, and, like the Japanese, they have no word for them. Midwives, medical personnel, and the women themselves reported that hot flashes simply do not occur, nor are they mentioned in books on Mayan botanical medicine.
The difference between Americans and Greeks and other Europeans on the one hand, for whom hot flashes are common, and the Mayans and Japanese on the other, for whom they are rare or unknown, appears to be diet. The Mayan diet consists of corn and corn tortillas, beans, tomatoes, squash, sweet potatoes, radishes, and other vegetables, with very little meat and no dairy products. Like the traditional Japanese diet, it is extremely low in animal products and low in fat in general. The Greek diet, while rich in vegetables and legumes, also contains meat, fish, cheese, and milk, as does the cuisine of other countries in Europe and North America. Animal-based meals affect hormone levels rapidly and strongly, and undoubtedly contribute to the menopausal problems that are common in Western countries.
For women who are experiencing hot flashes, there are useful steps in addition to the low-fat, vegetarian diet which is strongly recommended for so many reasons. Regular aerobic exercise helps. A vigorous walk every day or so, or any equivalent physical activity, seems to alleviate hot flashes.
- Eat a diet consisting of 50 percent raw foods and take a protein supplement to help stabilize blood sugar. Add blackstrap molasses, broccoli, dandelion greens, kelp, salmon with bones, sardines, and white fish to your diet.
- Do not consume any animal products except for those recommended in this section. Avoid dairy products and limit your consumption to small amounts of low-fat yogurt or buttermilk. Dairy products and meat promote hot flashes. They also contribute to a loss of calcium from the bones.
- Avoid alcohol, caffeine, sugar, spicy foods, and hot soups and drinks since they can trigger hot flashes, aggravate urinary incontinence, and make mood swings worse. They also make the blood more acidic, which prompts the bones to release calcium to act as a buffering agent. This is an important factor in bone loss.
- Substitute garlic or onion powder for salt when cooking. Consuming salt increases urinary excretion of calcium.
- Drink 2 quarts of quality water daily to help prevent the drying of the skin and mucous membranes.
- Calcium supplements if your diet does not provide at least 1000 mg of calcium a day.
- Include more phytoestrogens (plant estrogens) in the diet to help prevent or alleviate menopausal symptoms. These estrogen-like compounds are found in foods such as soybeans, tofu, miso, flaxseeds, pomegranates, and dates. When these substances are eaten, they act like the estrogens produced in the body.
- Gamma-orysanol, a nutrient derived from rice bran, has been shown to be effective in treating symptoms of menopause. A daily dose of 20 mg reduced symptoms by 50 percent in 67 percent of the women studied.
- Kombucha tea has detoxifying, energizing, and immune-boosting properties. Many women have found that using it regularly helps to increase vitality and diminish unpleasant menopausal symptoms. See Making Kombucha Tea for more information.
HERBS
A paste made from aloe vera gel and slippery elm powder, mixed to the consistency of toothpaste and inserted into the vagina at night, can relieve vaginal dryness.
Damiana enhances sexual desire and pleasure.
Amaranth, chickweed, dandelion greens, nettle, seaweed, and watercress are rich in calcium and can prevent osteoporosis.
Anise, black cohosh, fennel, licorice, raspberry leaf, sage, sarsaparilla, squawvine, unicorn root, and wild yam root are natural estrogen replacements. Caution: Do not use licorice on a daily basis for more than 7 days in a row, and avoid it completely if you have high blood pressure. Do not use sage if you suffer from any type of seizure disorder.
Chamomile and valerian root help to calm the body and promote restful sleep. Caution: Do not use chamomile on an ongoing basis, and avoid it completely if you are allergic to rag weed.
Gotu Kola and Dong Quai relieve hot flashes, vaginal dryness, and depression.
Andrew Weil, M.D., a well-known physician and author, recommends trying the herbs dong quai, chaparral, and damiana, two capsules of each taken once daily at noon, or, if used as a tincture, one dropperful in a cup of warm water. Vitamin E, in doses of 400 to 800 IU per day, has also been reported to be helpful. People with high blood pressure should use no more than 100 IU per day. Jesse Hanley, M.D., a family practitioner in Malibu, California, has found that certain Chinese herbs, called Changes for Women, by Zand Herbal, and Menofem, by Prevail, are helpful in reducing menopausal symptoms for some women. These supplements are available at most health food stores.
Siberian ginseng aids in relieving depression and in the production of estrogen. Caution : Do not use this herb if you have hypoglycemia, high blood pressure, or a heart disorder.
Note: Bulk herbs are available from Mountain Rose Herbs. Nutritional supplements, tinctures, extracts, tablets and capsules are available from HerbalRemedies.com. See links below.
MENOPAUSAL SUPPLEMENTS & PRODUCTS
Nutrients Supplement Suggested Dosage Comments Very Important Lecithin granules
Or
Capsules1 Tablespoon 3 times daily, before meals.
1,200 mg 3 times daily, before meals.Important as an emulsifier for vitamin E, which reduces hot flashes and related symptoms. Lecithin, Vegetarian Granules, NOW Foods, 97% Phosphatides, Pure and Fresh, 1 lb., Lecithin, Liquid, NOW Foods, Vegetarian, 16 fl. oz. Multi-enzyme complex
With
Hydrochloric Acid (HCl)As directed on label. Take with meals. To aid digestion
HCl production declines with age. Caution: Do not use HCl if you have a history of ulcers. Plant Enzymes, NOW Foods, Vegetarian, 120 VcapsPrimrose oil
Or
Black Currant Seed OilAs directed on label.
As directed on label.Act as sedatives and diuretics. Good for hot flashes. Important for production of estrogen. Evening Primrose Oil, NOW Foods, 100% Pure, 4 fl. oz., Evening Primrose Oil, Cold-Pressed, Nature's Way, 500 mg, 250 Softgels, Evening Primrose Oil, Cold-Pressed, Nature's Way, 1300 mg, 120 Softgels, Black Currant Oil, 500 mg, NOW Foods, 100 Softgels Vitamin B complex As directed on label. For improved circulation and cellular function. Use a sublingual form for best absorption. Or consider injections (under a health care provider's supervision). Ultimate B, B Complex Formula, Nature's Secret, 60 Tabs Plus extra
Pantothenic acid (Vitamin B-5)100 mg 3 times daily. A powerful anti-stress vitamin needed for adrenal function. Pantothenic Acid, 100% Natural Vitamin B-5, Nature's Way, 250 mg, 100 Caps And
Pyridoxine (Vitamin B-6)50 mg 3 times daily. Minimizes water retention and eases symptoms. Pyridoxine, Vitamin B-6, Nature's Way, 100 mg, 100 Caps Vitamin E Start with 400 IU daily and slowly increase the dosage until hot flashes are relieved, up to 1,600 IU daily. Reduces hot flashes and many other symptoms. Use emulsion from for easier assimilation and greater safety at high doses. Vitamin E 1000, NOW Foods, 1000 IU, 100 Gels, Vitamin E, 400 IU, 100% Natural, NOW Foods, 100 Gels, Vitamin E Skin Cream, NOW Foods, 28,000 IU, 4 oz. Important Boron 3 mg daily. Do not exceed this amount. Enhances calcium absorption. Boron Ionic Mineral Supplement, Fully Absorbable, 20 +/- ppm, 16 fl. oz., Ionic Boron Single Mineral, 6 mg, 2 fl. oz, Trace Minerals, Boron Chelate, Nature's Way, 3 mg, 100 Caps Calcium
And
Magnesium2,000 mg daily.
1,000 mg daily.To relieve nervousness and irritability, and to protect against bone loss. Use chelate forms. Just An Ounce, Calcium & Magnesium Liquid, Almond Flavor, 16 fl. oz., Cal-Mag Pre-Chelated Calcium &Magnesium, Vital Earth, 240 Gelcaps Silica As directed on label. Supplies silicon, needed for connective tissue and for calcium uptake. Cellfood Silica Liquid Drops, 4 fl. oz. (118 ml), Original Silica Gel Capsule, 90 Vcaps, Nature's Way Zinc 50 mg daily. Do not exceed a total of 100 mg daily from all supplements. Aids in protecting against bone loss and reducing symptoms. Use Zinc Gluconate lozenges or Optizinc for best absorption. Zinc Ionic Mineral Supplement, Fully Absorbable, 100 +/- ppm, 16 fl. oz., Ionic Zinc, 50 mg, 2 fl. oz., Trace Minerals, Zinc (Chelated), 100% Natural, Nature's Way, 30 mg, 100 Caps, Zinc Lozenges w/Echinacea & Vitamin C, Nature's Way, 23 mg, 60 Lozenges Helpful L-Arginine
And
L-Lysine500 mg twice daily.
500 mg daily, on an empty stomach. Take with water or juice. Do not take with milk. Take with 50 mg vitamin B-6 and 100 mg vitamin C for better absorption.Detoxifies the liver and ammonia.
Aids liver function. See Amino Acids for more information. L-Arginine, Pharmaceutical Grade, Free Form, NOW Foods, 500 mg, 100 Caps, L-Lysine, Pharmaceutical Grade, Stable Tartrate Form, NOW Foods, 500 mg, 100 CapsMeno-Fem from Prevail
(Note: Unable to locate on the internet)As directed on label. Contains gamma-oryzanol, a component of rice bran oil effective in controlling uncomfortable symptoms of menopause. Multi-glandular complex As directed on label. For hormonal stability. See Glandular Therapy for more information. Immuno-Gland Plex, Organic Glandular (Hypoallergenic), Allergy Research Group/Nutricology, 60 Caps Multi-vitamin & Mineral complex
With
PotassiumAs directed on label. Take with meals.
99 mg daily.All nutrients are needed for normal hormone production and function.
To replace potassium lost through perspiration during hot flashes. Alive! Whole Food Energizer, Multi-Vitamin & Mineral W/ Naturally Occurring Iron (No Iron Added), Nature's way, 180 Tabs, Alive! Whole Food Energizer, Rice & Pea Protein w/ Naturally Occurring Iron, Ultra-Shake Powder, Apple Cinnamon Flavor, Nature's Way, 2.2 lb.And
Selenium200 mcg daily. An important trace mineral linked to normal hormonal balance. Selenium Supplement, Yeast Free, NOW Foods, 200 mcg, 180 Caps, Selenium Ionic Mineral Supplement, Fully Absorbable, 50 +/- ppm, 16 fl. oz. Vitamin C 3,000 - 10,000 mg daily, in divided doses. For hot flashes. Vitamin C Liquid, w/Rose Hips & Bioflavonoids, Kosher, Natural Citrus Flavor, 1000 mg, 16 fl. oz., Dynamic Health, Vitamin C 1000 w/Bioflavonoids, Nature's Way, 100% Natural, 1000 mg, 250 Vcaps
HELPFUL PRODUCTS
Keat's Good Health Guide About Natural Progesterone Cream
In this Keat's Good Health Guide, Dr. Norman Shealy answers all your questions about natural progesterone cream, a viable and safe alternative to synthetic hormone replacement therapy. As a major building block for both testosterone and estrogen plus virtually all other adrenal hormones, natural progesterone can help prevent osteoporosis, ease PMS, menopausal symptoms, fibroids, migraine headaches, lift depression - and more. Offering health benefits to both men and women.
Book about Natural Hormone Replacement for Women over 45.
Wild Yam Cream from Dreamcastle contains progesterone and phyto-estrogens, which are natural estrogens found in plants. Wild Yam Cream is a safe, natural alternative to hormone replacement therapy without the risk of weight gain or other negative side effects.
ESTROGENEX - is a nutritional supplement, available without a prescription, designed to normalize all hormone levels, yielding a wide spectrum of health and anti-aging benefits.
Progesterone Cream helps women experiencing the symptoms of menopause. Progesterone Cream is a safe alternative to hormone replacement therapy. Progesterone Cream Contains progesterone and phyto-estrogens, natural estrogens found in plants. Progesterone Cream Avocado Oil is blended with vitamin E, Aloe Vera and other herbs for fast absorption & effectiveness.
Pre-menopausal symptoms, endometriosis, weight gain, low sex drive, fibrocystic breasts, heart disease, and osteoporosis-most women will experience these or other hormone-related problems. And today, millions of women concerned about aging must decide whether or not to undergo synthetic hormone replacement therapy and suffer its side effects and increased risks of cancer. But there is revolutionary news about completely safe, Natural Progesterone, the only hormone supplement women may need as they age. The exciting clinical findings from its use were first spread by word of mouth, then in a groundbreaking book written by acclaimed California physician John R. Lee. Now, in this expanded and completely updated edition, Dr. Lee brings you lifesaving facts that even your doctor may not know about Premarin, Provera, and other HRT drugs; gives you an easy-to-follow non-prescription "Hormone Balance" program; and tells you how to stay energized, strong, sexually vigorous, and free from "female problems" before menopause, during the menopausal years, and beyond.
Pre-menopausal symptoms, endometriosis, weight gain, low sex drive, fibrocystic breasts, heart disease, and osteoporosis - most women will experience these or other hormone-related problems. And today, millions of women concerned about aging must decide whether or not to undergo synthetic hormone replacement therapy - and suffer its side effects and increased risks of cancer. But there is revolutionary news about completely safe, natural progesterone, the only hormone supplement women may need as they age. The exciting clinical findings from its use were first spread by word of mouth, then in a groundbreaking book written by acclaimed California physician John R. Lee. Now, in this expanded and completely updated edition, Dr. Lee brings you lifesaving facts that even your doctor may not know about Premarin, Provera, and other HRT drugs; gives you an easy-to-follow non-prescription "Hormone Balance" program; and tells you how to stay energized, strong, sexually vigorous, and free from "female problems" before menopause, during the menopausal years, and beyond.
Based on current scientific research and our clinical experience, we have developed a formula that helps women through menopause while they avoid the risks that come with hormone replacement therapy.
Black cohosh (Cimicifuga racemosa) has been used traditionally as a relaxant, sedative, and antispasmodic. Menopause causes the signals between the ovaries and pituitary gland to diminish, slowing down estrogen production and increasing luteinizing hormone (LH) secretions. Hot flashes can result from these hormonal changes. A German clinical study demonstrated that an extract of black cohosh decreases LH secretions in menopausal women - but produces no hormonal changes. The studies, therefore, support the usefulness of black cohosh for symptomatic relief from hot flashes, but not as a substitute for hormone replacement therapy. 1 tsp. 2 to 3 times a day depending on condition.
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Click Here To Visit Herbal Remedies Product Page
NOTIFY YOUR MIDWIFE OR HEALTH CARE PROVIDER IF...
If you or a family member has symptoms of menopause. Other causes should be ruled out.
You experience excessive bleeding, prolonged periods or spotting between your expected periods. These may be signs of other disorders.
Bleeding appears 6 months or more after your last period.
New unexplained symptoms develop. Hormones used in therapy treatment may produce side effects.
Symptoms of menopause return while taking estrogen replacement therapy.
Prescription for Nutritional Healing: The A-To-Z Guide To Supplements
-- by Phyllis A. Balch, James F. Balch
Rebirth Natural Hormone Replacement Therapy
References
1. Colditz GA, Stampfer MJ, Willett WC, et al. Type of post-menopausal hormone use and risk of breast cancer: 12-year follow-up from the Nurses' Health Study. Cancer Causes and Control 1992;3:433-9.
2. Yang CP, Daling JR, Band PR, Gallagher RP, White E, Weiss NS. Non-contraceptive hormone use and risk of breast cancer. Cancer Causes and Control 1992;3:475-9.
3. Bergkvist L, Adami HO, Persson I, Hoover R, Schairer C. The risk of breast cancer after estrogen and estrogen-progestin replacement. N Engl J Med 1989;321:293-7.
4. Lock M. Contested meanings of the menopause. Lancet 1991;337:1270-2.
5. Beyene Y. Cultural significance and physiological manifestations of menopause: a biocultural analysis. Culture, Medicine, and Psychiatry 1986;10:47-71.
6. Follingstad AH. Estriol, the forgotten estrogen? JAMA 1978;239:29-30.
7. Heimer GM. Estriol in the post-menopause. Acta Obstet Gynecol Scand 1987;Suppl 139:3-23.
8. Molander U, Milsom I, Ekelund P, Mellstrom D, Eriksson O. Effect of oral estriol on vaginal flora and cytology and urogenital symptoms in the post-menopause. Maturitas 1990;12:113-20.
9. Gerbaldo D, Ferraiolo A, Croce S, Truini M, Capitanio GL. Endometrial morphology after 12 months of vaginal estriol therapy in post-menopausal women. Maturitas 1991;13:269-74.
10. DiRaimondo CV, Roach AC, Meador CK. Gynecomastia from exposure to vaginal estrogen cream. N Engl J Med 1980;302:1089-90.
11. Remer T, Manz F. Estimation of the renal net acid excretion by adults consuming diets containing variable amounts of protein. Am J Clin Nutr 1994;59:1356-61.
12. Nordin BEC, Need AG, Morris HA, Horowitz M. The nature and significance of the relationship between urinary sodium and urinary calcium in women. J Nutr 1993;123:1615-1622.
13. Massey LK, Whiting SJ. Caffeine, urinary calcium, calcium metabolism and bone. J Nutr 1993;123:1611-4.
14. Hopper JL, Seeman E. The bone density of female twins discordant for tobacco use. N Engl J Med 1994;330:387-92.
15. Mazess RB, Barden HS. Bone density in pre-menopausal women: effects of age, dietary intake, physical activity, smoking, and birth-control pills. Am J Clin Nutr 1991;53:132-42.
16. Lee JR. Osteoporosis reversal; the role of progesterone. International Clin Nutr Rev 1990;10:384-91.
17. Prior JC. Progesterone as a bone-trophic hormone. Endocrine Rev 1990;11:386-98.
18. Prior JC, Vigna Y, Alojado N. Progesterone and the prevention of osteoporosis. Canad J Ob/Gyn 1991;3:178.
This article is condensed from Eat Right, Live Longer, by Neal D. Barnard, M.D., Harmony Books, 1995.
