Understanding Menopause
A bittersweet point in a woman’s life is the “midlife crisis” of menopause. The sweet part is not having to deal with the monthly burden of the menstrual cycle anymore. The bitter part is worrying about potential health problems such as weaker bones, heart disease and stroke that can occur after menopause. Should a woman treat menopause as a health problem and “fight” this decreased hormone production, or instead see it as a natural stage in her life that requires lifestyle adjustments to minimize any health risks? It’s an important personal decision that should weigh all sides of the issue
Menopause is a natural stage in a woman’s life when the menstrual period stops,
and the child bearing years cease. Menopause is a natural part of the aging
process. The changes that occur are slow and are experienced differently by
everyone. Some women notice little difference in their body or mood, while
others may find it difficult to deal with their symptoms.
Perimenopause
The 5 to 10 years prior to menopause, when many of the common symptoms begin is
called perimenopause. This is when the ovaries begin making less of the female
hormones estrogen and progesterone.
Estrogen is made by the ovaries from puberty through menopause to thicken the
lining of the uterus every month in preparation for an egg implantation. If the
egg is not fertilized, the levels of hormones drop, and the uterus sheds it’s
lining.
As menopause approaches, the ovaries make less estrogen. One of the earliest
signs that menopause is near is a change in the menstrual period. One or more
periods may get skipped or the flow may become lighter or heavier. At some
point, the ovaries stop making enough estrogen to thicken the lining of the
uterus. This is when the menstrual period stops.
A small amount of estrogen is made by other glands such as the adrenals, and by
body fat. That is why some overweight women may not have symptoms of menopause
because their extra body fat allows them to make estrogen even after the
ovaries stop working. The adrenal glands produce small amounts of estrogen
after menopause.
THE SYMPTOMS
In addition to irregular periods, some common symptoms of menopause are:
85% of women experience one or more of these symptoms. The decision is whether
or not the symptoms are stressful enough to seek treatment. If they are, a
choice must be made as to which treatment is right.
Let’s examine the traditional medical approach, followed by a more natural approach.
THE MEDICAL APPROACH
Doctors sometimes prescribe the hormones estrogen and progestin, in a treatment
called hormone replacement therapy (HRT), to ease the signs of menopause. These
medications restore the falling levels of hormones back to the levels before
menopause began. This subsequently eliminates or at least reduces the severity
of the most common menopause symptoms. It is believed HRT also protects against
the possibility of osteoporosis, heart disease, stroke and possibly Alzheimer’s.
Current research support s the connection of HRT with a lessened risk of
osteoporosis, however, the protection from heart disease is much more murky.
The research this theory is based on did not take other factors into account
that could lead to a healthier heart. On the contrary, the latest studies that
are randomized, double blinded placebo controlled, including the HERS study and
the Women’s Health Initiative, are showing that HRT may actually increase the
risk of heart disease. Other risks of HRT include a possible increased risk of
uterine and breast cancer, especially when taken for over 5 years. The latest
studies show a higher rate of breast cancer with the combination of estrogen
and progestin than with estrogen alone (1.4 times vs. 1.2 times) JAMA April
2000. This risk is most prevalent in lean women compared to heavy women, and
decreases rapidly once the HRT is discontinued. The researchers suggested that
HRT was beneficial for short-term use (2-3 years) for relief of menopausal
symptoms, and then should be gradually tapered off. They recommended other
methods of improving bone and heart health, specifically, exercise, diet, and
smoking cessation.
THE NATURAL APPROACH
Many women do not wish to undergo hormone replacement therapy either due to the
belief that it “medicalizes” a natural phenomenon, or because they have a
family history of breast or uterine cancer. Whatever the reasoning, there are
natural ways to reduce the severity of the transitional menopause symptoms, as
well as counteract the risks of heart disease and osteoporosis.
A woman MUST be dedicated to a program of regular exercise consisting of weight
bearing exercise (jogging or walking), lifting weights and cardiovascular
exercise to elevate the heart rate and ward off heart disease and reduce
osteoporosis. Avoiding smoking, alcohol, coffee, soda and excess protein,
especially from animal products helps to reduce the amount of calcium leeched
from the bones. A diet consisting mostly of vegetables, high fiber, fish, and
vegetable protein like tofu benefits both the bones and the heart. Another
important factor is reducing the acidity of the blood that is commonly acidic
from the standard American diet. This will be obtained by following the above
recommendations.
In addition, there are several herbs and nutrients that help to ease the
symptoms of the menopause transition. Dong quai contains plant sterols that
have mild estrogenic effects. Other foods that contain “phyto-estrogens”
include soy products, papaya, apples, carrots, yams, green beans, peas
potatoes, red beans, brown rice, sesame seeds. These foods contain 1/400th or
less estrogen than a single dose of hormone supplement, but a steady diet of
these foods may provide enough nutrients to lessen the effects of menopause.
Bioflavonoid, vitamin E, primrose oil, black cohosh, wild yam, chaste berry,
and ginseng all have shown promise in reducing hot flashes and other symptoms.
Homeopathic and Ayurvedic formulations have provided some women with
substantial relief.
NATURAL HORMONE REPLACEMENT
Another possibility is natural hormone therapy consisting of natural
progesterone, and natural estrogen. Premarin is made from pregnant mare’s urine
(hence the name) and doesn’t contain the same balance of hormones. Human female
estrogen consists of 90% Estriol, 3% Estrone, and 7% Estradiol. Premarin on the
other hand consists of 75% Estrone, 10% equlin (a horse estrogen), and 15%
Estradiol and 2 other equine estrogens. In other words, Premarin has larger
proportions of Estrone and several forms of estrogen found exclusively in
horses. There are formulations of natural estrogen that exactly correspond with
the natural balance found in humans.
In addition, the synthetic progesterone-like hormone Progestin, is frequently
prescribed with Premarin and can increase the risk of cancer of the uterus,
initiate menstrual bleeding again, and reduce the protective effects of
estrogen on the heart. Natural forms of progesterone in a cream form have been
shown in studies to assist in the reduction of typical menopause symptoms while
not producing the negative effects of the synthetic Progestin listed above.
Some brand names include Prometrium, Dydrogesterone, and Duphastan, which are
available in a pill or cream.
SUMMARY
The choices that a woman must make regarding the path to choose during
menopause are very individualized and personal. The decision should carefully
consider all the potential options and risks. Education is very important, as
is a thorough investigation of any family history of diseases, an understanding
doctor, supportive friends, as well as support groups in your community. There
is no clear right or wrong answer on this issue at this time. Research seems to
be showing more risks than benefits of HRT, however not enough good studies
have been conducted thus far to fully endorse natural procedures without
question. You must find a path that works best for you as an individual