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:

1. hot flashes

2. changes in sleeping patterns

3. vaginal dryness

4. weight gain

5. weakened bones

6. decreased heart health

7. memory loss

8. decreased ability to handle alcohol and caffeine

9. irritability

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