Womenopause
While I was trying to decide whether to write this article on menopause or miscarriage, I found myself surrounded by women asking me about their hot flashes, even at a potluck brunch last week. When I mentioned the upcoming article, one of the women exclaimed, "Be sure to say that it should never have been called 'menopause'! After all, it's we women who experience it, not men." I told her I never thought of it that way, but that I could see her point.I began to feel that this article on meno- pause somehow wanted to be written. Then, yesterday, I received a call from a free-lance writer on the East coast who asked me if I could give her information on the homeopathic treatment of menopause because she felt it was a topic so many women were thirsting to know about. So, here's the article the universe seems to be asking me to write. Please forgive me if it seems hypocritical to keep using the word "menopause" despite what I've already mentioned but, whether we like it or not, it's the term we're most familiar with. The term menopause refers specifically to the final stopping of the menstrual flow in a woman's life; perimenopausal to the time around this last period; and post-menopausal to after the last period. Climacteric is another term which may encompass the entire time period.
Menopausal Myths
Let me begin by sharing some of our common myths about the menopausal experience.
- Menopause is inevitable. There's not much I can do to delay it. You're right that you can't avoid menopause (that's not to say every woman even wants to!) but certain lifestyle factors such as smoking, drinking too much alcohol or coffee, or significant emotional stress can bring on menopause earlier.
- Doesn't every body have to go through hot flashes? Most women, about four out of five, do experience hot flashes, to a greater or lesser degree, but the frequency, intensity, and duration varies tremendously. For some women it's terribly uncomfortable and embarrassing; for others only a minor irritation.
- I had my ovaries removed in my twenties because of cancer and have been on hormones ever since, so I don't have to go through hot flashes. Women who have had their ovaries removed and taken supplementary estrogen for a number of years can still get hot flashes once they stop taking the hormones.
- The only way to get rid of hot flashes and vaginal dryness is to take estrogen. Homeopathy, herbs, diet, nutritional supplements, and other natural thrapies can be very effective in treating these symptoms, and a growing number of women are thinking twice about automatically taking hormones once they reach menopause.
- All I have to do to prevent osteoporosis is to take plenty of calcium. Taking calcium supplementation, however large the amount, is not sufficient to prevent osteoporosis, as you'll understand more later in this article.
- So much for my sex drive! Menopause does not necessarily mean a plunge in sexual energy. Many women find sex quite pleasureable, and more liberated, after the menopausal years.
These are only a few of the many misconceptions about menopause and new information is surfacing all the time to separate menopausal facts from fallacies. Three books which I found helpful in sorting out current information are Menopause Naturally by Sadja Greenwood (which provides lots of good medical information and support but actually not much in the way of natural therapies), The Calcium Plus Workbook by Evelyn Whitlock and McDougall's Medicine: A Challenging Second Opinion by John McDougall. I'd like to share with you what I feel is most important about menopause, answer questions I hear many women ask about the experience, and give you some ideas about natural treatment which you can consider for yourself.
When can I expect to stop having periods and what will it be like?
Most women stop having periods somewhere between 48 and 52, but this may occur earlier or later, depending on lifestyle, heredity, and other factors. Hot flashes, vaginal dryness, and night sweats are the most common symptoms, however many women also experience delayed or more frequent periods, heavy or scant menstrual bleeding, and mood changes such as irritability or depression. These symptoms may occur fleetingly, or may last for several years or more. I've seen a number of women who have made the transition through menopause quite easily, with a minimum of symptoms. Other women, usually those who went through menopause without knowing help was available for them, may have a different story to tell and be very glad that it's all over. Many women think they're starting menopause in their early forties, then discover that their abnormal bleeding is caused by uterine fibroids (see the August, l990 issue of The New Times for more information).
How can I be sure I'm going through menopause?
If you are in your late forties or early fifties, are having the symptoms mentioned above, and your periods or changing or have stopped, it is highly likely that menopause is occuring. It is important to consult with a physician you trust, either a gynecologist or an alternative practitioner such as a naturopath, or both, for a number of reasons, rather than just going it on your own. If there is abnormal bleeding, it may be important to rule out other causes besides menopause, such as cervical, uterine, or ovarian cancer or fibroids, which are unlikely, but possible. In some cases, it is important to get very specific information through measuring blood levels of the various types of estrogen ad of progesterone. New tests are available to measure the amount of bone loss, preferably during the first year after menopause, when up to 30% of the loss is said to occur. Menopause is a very literally a change of life which necessitates your making some choices. If you choose to take hormones, you need regular gynecologic care. If you choose not to, there are definite dietary, vitamin/mineral, and lifestyle recommendations which are very important for you to integrate into your life. Choosing simply to avoid the issue entirely and hope that all works out for the best is, in my opinion, not a responsible option.
What about hormones for menopause?
The use of estrogen replacement therapy (ERT) for women who have reached menopause with at least one ovary is quite controversial and a very personal decision on the part of each woman. Opinions on the subject range from the vehemently anti-hormone philosophy espoused in Women and The Crisis in Sex Hormones by Seaman to the attitude that, "Of course, you need to take hormones" of orthodox gynecologists. I would estimate that 30 to 40% of my women patients experiencing menopause choose to take estrogen. ERT is usually effective in eliminating or improving hot flashes, vaginal dryness (often in conjunction with a vaginal estrogen-containing cream), night sweats as well as preventing osteoporosis. It may not address other symptoms such as wrinkling, aging, and psychological concerns.
In the mid-70's, by which time ERT had been very popular for ten or fifteen years, research began to indicate that ERT in post-menopausal women could increase the risk of uterine cancer fivefold. There followed a dramatic decrease in the use of ERT. More recently, evidence has shown that the use of progestin, a hormonal supplement similar to the natural hormone progesterone, for l0 to l4 days at the end of each 25 day regimen of estrogen is protective against uterine cancer. Estrogen is now available in a number of different preparations as well as both orally and in patches, which have the definite advantage of bypassing the liver.If you decide to go ahead and use ERT, consider the various forms carefully before deciding. Menopause Naturally provides good information on this subject. Some of the disadvantages of ERT are continued monthly periods, as least for a while, the need for regular gynecologic visits, the expense of the hormones, and the possibility of uterine cancer, liver or gall bladder disease, high blood pressure, clots, strokes, and depression. Though progesterone does lower the incidence of uterine cancer, it also can predipose to weight gain and may be implicated in high blood pressure, stroke, heart disease, and breast cancer.
Be sure to get all the information before deciding one way or the other about hormones. Similar to deciding whether to receive immunizations, it's a very personal decision with possible consequences way after the actual decision is made. Menopause can be a natural process rather than a disease. Many women got along quite well through menopause before the introduction of estrogen replacement and still do in many cultures. The philosophy that "every woman needs to continue having periods in order to stay healthy after menopause and avoid osteoporosis" is, I feel, absurd.
What about osteoporosis?
Osteoporosis is a demineralization of the bones which occurs after menopause to a serious degree in about 25% of white, Asian, and brown-skinned women. Black women have thicker bones, which puts them much less at risk for osteoporosis. This softening and weakening of the bones is what causes the fractures we often hear about in older women. Many women are very cautious about falling and breaking a hip; however if a woman has severe osteoporosis, her bones can break anytime, even from just walking across the room. It is possible to assess your risk level of osteoporosis through such tests as DPA (dual-photon absorptiometry) which measures the density of bone in the vertebrae of your lower back, or a CT scan, which offers the same results but has a consequence of greater exposure to radiation, as well as through an X-ray of the bones of the hand. These tests may be current state of the art, but still do not offer a really accurate predictor of risk of osteoporosis. A cruder method is to measure your height a year or two after menopause and compare it to your former height.
There are some definite steps you can take to decrease your risk of osteoporosis. Women who are slim with small muscle mass, particularly if they are short, are at increased risk. SO, in this case, it's actually good to keep a little extra fat on your bones. This is because estrogen is stored in fat cells. This is not to suggest, however, to gain a lot of weight, which would increase your incidence of heart disease. Other factors which increase your risk of osteoporosis are a history of repeated, easily broken bones, a family history of osteoporosis, menopause prior to age 40, daily use of cortisone , thyroid, Dilantin, or aluminum-containing antacids, renal dialysis, or chronic ciarrhea or surgical removal of part of the stomach or small intestine. There is clear evidence that women with a low protein intake decrease their risk. The best thing you can do for yourself, especially, but not only, if you prefer not to take ERT, is to eliminate red meat from your diet. Taking the next step of avoiding chicken and fish, also animal proteins, further decreases your risk. Other ways to lower your risk are to avoid or minimize alcohol and caffeine, not smoke, minimize salt, exercise regularly, and be sure to supplement calcium and vitamin D.
What if I don't choose to take hormones?
There are several important considerations if you choose not to take hormones which, I feel, is a very viable option. First, what is your risk of osteoporosis? If it is extremely high or you are unwilling to follow the recommended dietary and lifestyle recommendations, estrogen may be your best bet. In my experience, hot flashes are not difficult to treat. Vitamin E (assuming you don't have high blood pressure) may work for you). If not, constitutional homeopathy is extremely effective. Vaginal dryness often responds to Vitamin E suppositories. Several of my patients have recommended a product called Slippery Stuff, which I know nothing about, to ease their vaginal dryness during intercourse. I always assess a woman's Ayurvedic body type (a 5000 year-old, extremely comprehensive form of medicine from India)to individualize recommendations for menopause. There are also a number of herbs which have estrogenic (Burdock, Sage, Dong Quai, Cimicifuga, and others) or progesteronic (Licorice, WIld Yam, Smilax) properties. Supplementation with a high-quality multi-vitamin and mineral, calcium (best in the form of calcium citrate which is significantly better absorbed than other forms of calcium), vitamin D, and boron (a trace mineral which has been shown recently to significantly reduce urinary excretion of calcium and magnesium and to cause an increase in serum beta-estradiol, a form of estrogen). It is important for women not on estrogen, particularly those who don't follow the above dietary recommendations carefully, to take between l200 and l500 mg. of calcium daily, preferably half with meals (hydrochloric acid stimulates calcium absorption) and halfat bedtime (because phytates, found in some high complex carbohydrates, interfere with calcium absorption). It is important to realize, however, that calcium supplementation by itself, has not panned out, in recent studies, to significantly prevent osteoporosis. Magnesium increases calcium absorption and should also be taken daily. I also use another supplement containing Vitamin K and parathyroid which further enhances calcium absorption. Regular aerobic exercise for at least 20 minutes 4 to 5 times a week is, for post-menopausal women, an absolute necessity to prevent osteoporosis. It can also be very helpful to support the woman's liver during this time, since the liver is responsible for breaking down estrogen and a sluggish liver will make estrogen less available in the body. This can be done through herbs, lipotrophic factors, and liver cleansing.
The psychological and spiritual aspects of menopause.
The post-menopausal years can be a truly wonderful and gratifying period of a women's life, maybe even the best ever. It is a time, for most women, when they no longer have to attend to children and can focus more love and attention on themselves and their own needs. There is no longer the concern about becoming pregnant, which is a relief to many women, and make make sex a freer experience. And there is the opportunity to enjoy the fruits of one's professional, personal, and spiritual wisdom. In India, the time when one's children are grown is considered the beginning of sanyas or renun-ciation for men or women who so choose. They are encouarged to spend the rest of their life seeking their Oneness with God. If you find yourself, during or after menopause, filled with despair, resentment, fears about the future, get help so that this can be the beautifully rewarding change in your life that you have waited for and so fully deserve.
©Dr. Judyth Reichenberg-Ullman, ND, MSW, DHANP
Northwest Center for Homeopathic Medicine
www.healthyhomeopathy.com
(206)774-5599
Learn more about Menopause
- The Great Awakening--Menopause by Dr. Loretta Lanphier
- The Ayurvedic Approach to a Healthy Menopause and Natural Hormone Replacement Therapy by Nancy Lonsdorf, M.D.
