Menopause

DESCRIPTION

The permanent cessation of menstruation (menopause) may occur as early as age 40 or as late as 55, but the average age when menopause occurs is 51 years. The commonly accepted criterion for diagnosing menopause is 6–12 months without a menstrual period. Menopause is only one event in the “climacteric” a series of biological changes in body systems and tissue that occurs in both sexes between the mid-40s and mid-60s.

The time period, typically 2–3 years, prior to menopause is referred to as perimenopause (“peri” meaning “around”), while the time period after menopause is referred to as postmenopause. During perimenopause, many women ovulate irregularly due to fluctuations in oestrogen secretion and/or resistance of the remaining egg follicles to ovulatory stimulus.

Menopause occurs when virtually no eggs remain in the ovaries. At birth, about one million eggs (or ova)
are contained within the ovaries. At puberty, this number drops to 300,000–400,000, but only about 400 ova actually mature during the reproductive years. By the time a woman reaches 50, few viable ova remain. The absence of active follicles (the cellular housing of the eggs) results in reduced production of oestrogen and progesterone. In response to this drop in oestrogen, the pituitary gland increases its secretion of folliclestimulating hormone (FSH) and luteinizing hormone (LH), which continue to be secreted in large quantities after menopause. Although no egg follicles remain to stimulate, FSH and LH stimulate the ovaries and adrenal glands to secrete increased amounts of androgens, which can be converted to oestrogens by fat cells in the hips and thighs. In postmenopausal women, converted androgens provide some circulating oestrogen, but total oestrogen levels are far below those of menstruating women.
Although in the United States, menopause is associated with a variety of unpleasant symptoms and treated as a disease, in many cultures of the world, achieving menopause is synonymous with acceptance as a respected elder and relief from childbearing. In such traditional cultures, discomfort due to menopausal symptoms is reported far less frequently than in the US.

Menopausal symptoms are not, however, merely the result of negative social conditioning in the West. Of equal impact on a woman’s transition through menopause are the physiological stresses imposed by the Standard American Diet and exposure to the wide variety of environmental toxins commonplace in the West. Not only are women in the West told that menopause is an “oestrogen-deficiency disease”, which will leave them sexless “caricatures of their former selves … the equivalent of a eunuch”, they must also traverse this period of significant physiological change while bombarded with literally thousands of potentially toxic chemicals (e.g., pesticides, cleaning products, cosmetics, food additives, and drugs), and while consuming a diet based on animal products and processed foods that is low in protective factors – antioxidants, essential fatty acids, vitamins and minerals – and high in damaging factors that elevate cholesterol levels, blood pressure, and risk for obesity, cancer and diabetes – saturated fat, trans fats (also called partially hydrogenated oils), sugars, refined carbohydrates, pesticide residues and chemical additives.

These negative factors need not dominate a woman’s evolution through menopause. Natural medicine offers a variety of well-documented health-promoting therapies to support a graceful transition through the
climacteric to the next phase of a vital, healthy life.

 

FREQUENT SIGNS AND SYMPTOMS

As the body attempts to maintain its former state of hormonal balance, hormone levels (particularly oestrogen levels), may fluctuate widely causing the following symptoms.

Menstrual irregularity:

• Periods may occur more frequently than normal (e.g., every 21–24 instead of 28 days) or may not occur for one to several months
• Spotting between periods
• Periods may be heavier or lighter than usual.

Hot flashes or flushes: sensations of heat spreading from the waist or chest toward the neck, face and upper arms:

• Hot flashes are caused by a dilation of the peripheral blood vessels, which leads to a rise in skin temperature and flushing skin, especially of the head and neck. Skin becomes red and warm for a few seconds to 2 min, with cold chills following.
• In the US, 65–85% of women experience hot flashes to some degree.
• Hot flashes are often the first sign of approaching menopause, but are usually most frequent in the first and second years after menopause as the body adapts to decreased oestrogen levels.

Headaches: these are due to increased instability of blood vessels and often accompany hot flashes.

Dizziness, rapid irregular heartbeat: also related to vascular instability and may accompany hot flashes.

Hypoglycemic symptoms: suddenly feeling weak or shaky, breaking out in a cold sweat.

Atrophic vaginitis: thinning and drying of the lining of the vaginal canal due to lack of oestrogen. May
cause painful intercourse, increased susceptibility to infection, and vaginal itching or burning.

Bloating in the upper abdomen.

Frequent urinary tract infections: about 15% of menopausal women experience frequent bladder infections due to a breakdown in the natural defense  mechanisms that protect against bacterial growth in the urinary tract.

Bladder irritability

Breast tenderness

Cold hands and feet

Mood changes

Pronounced tension and anxiety

Sleeping difficulty

Forgetfulness, an inability to concentrate

Depression or melancholy and fatigue

CAUSES

Menopause

• A normal decline in ovarian function resulting in decreased levels of the female hormones, oestrogen and
  progesterone
• Surgical removal of both ovaries

Menopausal symptoms

• Diet: consumption of the Standard American Diet and exposure to numerous environmental toxins significantly exacerbates the stress placed on a woman’s system, which is attempting to maintain balance while undergoing physiological change to a new state of equilibrium.
• Psychological: cultural devaluation of older women in the West.

 

• RISK INCREASES WITH

Smoking: women who smoke have double the risk of early menopause (menopause beginning as early as age 44).

PREVENTIVE MEASURES

Menopause is a normal part of life that cannot be avoided, but the majority of negative effects frequently associated with menopause can be largely prevented or alleviated.

Atrophic vaginitis

• Keep well hydrated: drink at least 1.5 L (3 US pints) of clean (filtered) water daily.
• Avoid substances that dry the mucous membranes: these include antihistamines, alcohol, caffeine, diuretics.
• Wear clothes made from natural fibers, e.g., cotton, which allow the skin to breathe, thus preventing development of the hot, moist environment that favours vaginal infections.
• Regular intercourse: frequent sex increases blood flow to vaginal tissues, thus helping to improve tone
  and lubrication. If needed, maintain good lubrication with oil or K-Y jelly.
  

Bladder infections

• Drink large quantities of fluids (at least 2 L [4 US pints] q.d.), including at least 0.5 L (1 US pint) of unsweetened cranberry juice or 0.25 L (8 US fl oz) of blueberry juice each day to:
• Enhance the flow of urine by maintaining good hydration
• Prevent bacterial adherence to the lining of the bladder. In order for bacteria to infect, they must first adhere to the mucosal lining of the urethra and bladder. Components found in cranberry and blueberry juice reduce the ability of Escherichia coli to adhere.
• Minimize consumption of sugars and refined foods: consuming 75 g (3 oz) of sugar in one sitting in
  any form (sucrose, honey, fruit juice) depresses white (immune) cell activity by 50% for 1–5 hours, thus
  significantly increasing susceptibility to infection.
• For more detailed information, including several botanical medicines that can be employed against
  bladder infections, see the chapter on Cystitis.
  

Cold hands and feet

• The three major causes of cold hands and feet are hypothyroidism, low iron levels in the body, and poor circulation.
• The following tests may be suggested:
• Basal body temperature test (Ask staff at ICIM Medics about this) to evaluate thyroid activity
• Serum ferritin levels, a laboratory test that checks the amount of ferritin in the blood, the best indicator of
  body iron stores
• CBC (complete blood count) and chemistry panel that includes low density lipoprotein (LDL)/high density lipoprotein (HDL) cholesterol levels
• A physical examination for any other causes of decreased blood flow.
  

Forgetfulness and inability to concentrate

• These symptoms are often due to decreased oxygen and nutrient supply to the brain caused, not by menopause, but atherosclerosis (hardening of the arteries).
• Regular exercise, a health-promoting diet low in factors that damage the cardiovascular system (saturated
  and trans fats, alcohol, sugars, refined foods), and the botanical medicine, Ginkgo biloba – all discussed below – will significantly enhance the supply of oxygen and nutrients to the brain.
  

Expected outcomes

Most women will become virtually asymptomatic within 4–6 weeks after instituting the natural approach that targets the underlying causes of their symptoms. While hormone replacement therapy (HRT) is currently the standard allopathic treatment for menopausal symptoms, HRT is not without potentially serious adverse side effects. Rather than immediately using HRT to artificially counteract menopausal symptoms, the natural approach first focuses on improving physiology through diet, exercise, nutritional supplementation and botanical medicines.

 
Side effects of hormone replacement therapy

• The cancer-causing potential of HRT is a serious concern. Breast cancer, the most common cancer in women, is the form most likely to be exacerbated since estrogens play a critical role in the development of
  most breast cancers. Current estimates are that one in nine women in the US will develop breast cancer in her lifetime.
• Despite more than 50 studies, the cancer risk of HRT is still not clear, but experts have calculated that oestrogen replacement therapy is associated with a 1–30% increase in breast cancer risk.
• Most of the studies showing that HRT increases cancer risk were conducted in Europe, while most of those in the US have found no increased risk. Several hypotheses have been advanced to explain this surprising difference including:
• American researcher bias
• The years-long US medical establishment’s enthusiastic recommendation of oestrogen replacement
  therapy
• American women are already at such high risk for breast cancer that the effect of oestrogen replacement
  is difficult to measure.
• In addition to possible increased risk for cancer, synthetic oestrogen and progesterone products increase
  risk for gallstones and blood clots, and cause nausea, breast tenderness, symptoms similar to PMS, depression, liver disorders, enlargement of uterine fibroids, fluid retention, blood sugar disturbances, and
  headaches.
• In the Nurses Health Study of more than 23,000 women, postmenopausal women on synthetic hormone
  replacement were also found to be twice as likely to suffer from adult-onset asthma, this side effect being dose related. This finding is not surprising since the incidence of asthma in women soars at the onset of puberty when oestrogen levels begin to increase.

Type of hormone replacement therapy

If, after weighing all the evidence with a physician, HRT is chosen – either for short-term relief or for long-term use because of a high risk for osteoporosis – natural hormone replacement using hormones identical to human oestrogen and progesterone is recommended.

• Conjugated estrogens (e.g., Premarin, Genisis), which are derived from pregnant mares’ urine, progestins
  (synthetic progesterone formulations) and medroxyprogesterone products (e.g., Provera, Cycrin, Amen)
  are not biochemically identical and do not produce effects identical to human hormones.
• Human oestrogen is actually composed of three estrogens: estriol, estrone, and estradiol. Tri-Est, a
  formulation containing these three natural forms of human oestrogen in a ratio equivalent to that found in
  the human body along with natural progesterone, derived from wild yam but biochemically identical to human progesterone, is preferred.
• A salivary hormone profile test to determine current hormone levels may be suggested, together with working with a compounding pharmacist to develop a natural hormone replacement prescription that meets specific needs.
  

TREATMENT

Diet

Increase the amount of plant foods, especially those high in phytoestrogens, e.g., soy, flaxseed and flaxseed oil, nuts, whole grains, apples, fennel, parsley, and alfalfa:

• A diet rich in fruits and vegetables not only eases the transition through menopause, but also provides protection against chronic degenerative diseases including heart disease, breast cancer, arthritis, cataracts, etc.:
• As oestrogen levels drop, a woman’s risk of heart disease increases significantly. Heart disease is the leading cause of death in women over 50.
• Phytoestrogens are plant compounds capable of binding to oestrogen receptors that can help balance oestrogen’s effects whether oestrogen levels are too high or too low:
• Particularly during perimenopause, oestrogen levels may fluctuate widely as the body attempts to compensate for declining ovarian oestrogen production. These abrupt shifts in oestrogen levels are responsible for many of the symptoms associated with menopause in the West.
• Although phytoestrogens’ activity is only 2% as strong as that of human oestrogen, if oestrogen levels are low, the net effect is an increase in estrogenic activity. If oestrogen levels are too high, phytoestrogens lower oestrogen’s effects by binding to oestrogen-receptor sites, thereby preventing oestrogen from doing so.
• Increasing dietary intake of phytoestrogens helps decrease hot flashes, increase maturation of vaginal cells, and inhibit osteoporosis.
• A diet rich in phytoestrogens results in decreased frequency of breast and colon cancer.
• Synthetic and even natural unopposed oestrogen replacement pose significant health risks including increased risk of cancer, gallbladder disease, strokes and heart attacks:
• Phytoestrogen-containing foods and herbs have not been associated with any of these side effects, and in addition, have been found extremely effective in inhibiting breast cancer by occupying oestrogen receptors and via other anticancer mechanisms.
• Consumption of soy foods reduces cancer risk, vaginal atrophy, and heart disease risk:
• Genistein and daidzein, the isoflavones (phytoestrogens) in soybeans produce a mild estrogenic effect.
  One cup of soybeans provides approximately 300 mg of isoflavone, the equivalent to 0.45 mg of conjugated estrogens, or one tablet of Premarin:
• While Premarin therapy is associated with an increased risk of cancer, consumption of soy foods is associated with a significant reduction in cancer risk.
• In one study of postmenopausal women, those who consumed enough soy foods to provide 200 mg of isoflavone q.d. had an increase in the number of superficial cells that line the vagina, thus preventing the vaginal drying and irritation common in postmenopausal women.
• Soy also protects LDL cholesterol from oxidation, an extremely important protective effect for the prevention of cardiovascular disease.
• Soybeans’ safety is demonstrated by the fact that they have been cultivated as food for more than 13,000 years in China.
• Consume products made from whole soybeans  (soy flour, whole soy) rather than those produced from
  soybean protein concentrates:
• Products made from whole soybeans are higher in isoflavonoid content.
• Soy protein isolates contain no isoflavones.

Nutritional supplements

Clinical studies have found the following nutrients effective in relieving hot flashes and atrophic vaginitis:

• Vitamin E: found primarily in the lipid (fatty) membrane of cells, which it protects from free radical damage, vitamin E is the main antioxidant in all fat-soluble areas of the body. A healthy cell membrane is essential for the passage of nutrients into and wastes out of cells, so an adequate supply of vitamin E is essential for healthy cellular metabolism. Vitamin E is particularly important during menopause as it not only relieves menopausal symptoms but also protects against cancer and heart disease:
• In several clinical studies, vitamin E has been found to improve blood supply to the vaginal wall and to
  relieve atrophic vaginitis and hot flashes.
• In premenstrual syndrome and fibrocystic breast disease, two other female complaints related to hormonal imbalances, vitamin E has been shown to normalize circulating hormone levels, relieving many symptoms.
• Of all the antioxidants, vitamin E may offer the most protection against cardiovascular disease. Vitamin
  E reduces LDL (bad) cholesterol peroxidation, improves plasma LDL breakdown, inhibits excessive platelet aggregation, increases HDL (good) cholesterol levels, and increases the breakdown of fibrin, a clot-forming protein.
• Vitamin E significantly enhances both types of immune defense: non-specific or cell-mediated immunity and specific or humoral immunity. Cell-mediated immunity is the body’s primary mode of protection against cancer.
  Oral use and topical use - – vitamin E oil, creams, ointments or suppositories can be used topically for symptomatic relief of vaginal dryness and irritation.
• Hesperidin: like many other flavonoids, hesperidin improves vascular integrity, lessening excessive capillary permeability – a primary factor in hot flashes:
• After 1 month’s supplementation of hesperidin in combination with vitamin C, symptoms of hot flashes were relieved in 53% of patients and reduced in 34%. Nocturnal leg cramps, nosebleeds and easy bruising were also lessened. The only side effects were a slight body odour and a tendency for perspiration to discolour clothing.
• Vitamin C: vitamin C, the body’s primary antioxidant in all water-soluble areas inside and outside cells, works synergistically with vitamin E and carotenes (its fat-soluble partners):
• As noted under hesperidin, vitamin C helps to alleviate hot flashes by strengthening the collagen structures of the vascular system, thus preventing excessive capillary permeability.
• Vitamin C regenerates oxidized vitamin E, enabling it to resume its many beneficial activities.
• Vitamin C is extremely effective in its own right in protecting against cardiovascular disease by preventing oxidation of LDL cholesterol, raising HDL cholesterol levels, lowering the total cholesterol level and blood pressure, and inhibiting platelet aggregation.
• Gamma-oryzanol (ferulic acid): a growthpromoting substance found in grains and isolated from rice bran oil, gamma-oryzanol has been shown to be effective in alleviating menopausal symptoms including hot flashes and also to lower blood cholesterol and triglyceride levels:
• In treating hot flashes, gamma-oryzanol’s primary action is to enhance pituitary function and promote release of endorphins by the hypothalamus
• An extremely safe, natural substance, gammaoryzanol has produced no significant side effects in experimental or clinical studies.

Botanical medicines

The following botanicals are often referred to as uterine tonics. Their positive effects are thought to result from the phytoestrogens they contain and their ability to improve blood flow to the female organs. While effective individually, these herbs are often combined to produce even greater benefit.

• Angelica sinensis (dong quai): the predominant “female” remedy in Asia, dong quai is used to treat menopausal symptoms (especially hot flashes), as well as menstrual difficulties (painful menstruation, too
  frequent menstruation, lack of menstruation), and to ensure a healthy pregnancy and delivery:
• Dong quai’s active components have both mild estrogenic effects and a stabilizing action on blood vessels, both of which contribute to its effectiveness in relieving hot flashes.
• Glycyrrhiza glabra (licorice): during perimenopause, oestrogen levels fluctuate widely while progesterone levels consistently drop. Licorice increases the estrogen-to-progesterone ratio by lowering oestrogen levels while simultaneously raising progesterone levels, thus restoring hormonal balance:
• Vitex agnus-castus (chasteberry): chasteberry’s profound effects on pituitary function, specifically altering LH and FSH secretion, are likely the cause of its beneficial effects on menopausal symptoms:
• Although traditionally used in countries around the Mediterranean to suppress libido of women of childbearing age, chasteberry does not reduce libido during menopause.
• Cimicifuga racemosa (black cohosh): a special extract of Cimicifuga standardized to contain 1 mg of triterpenes calculated as 27-deoxyactein per tablet (trade name Remifemin) is the most widely used and thoroughly studied natural alternative to HRT:
• In 1997, 10 million monthly units of this extract were sold in Germany, the US, and Australia. A large open study involving 131 doctors and 629 patients found Cimicifuga extract produced clear improvement in menopausal symptoms (hot flashes, depression, vaginal atrophy) in over 80% of patients within 6–8 weeks.
• Additional studies that have compared Cimicifuga to conjugated oestrogens (0.625 mg q.d.) or diazepam (a Valium-like drug) (2 mg q.d.) indicate Cimicifuga extract is far more effective than either drug in relieving hot flashes, vaginal atrophy, and the depressive mood and anxiety associated with menopause.
• Cimicifuga not only does not stimulate breast tumour cells, but even inhibits their growth:
• When combined with tamoxifen (an antiestrogen drug often used to prevent a recurrence of breast cancer), Cimicifuga improved tamoxifen’s effectiveness.
• Detailed toxicology studies have shown no mutagenic or carcinogenic effects, indicating that even long-term use is safe.
• Ginkgo biloba extract: ginkgo’s effects of improving blood flow throughout the vascular system make it
  especially useful for the cold hands and feet and the forgetfulness that often accompany menopause:
• In human clinical trials, Ginkgo extract has been shown to be effective in the treatment of Raynaud’s disease, a peripheral vascular disease of the extremities characterized by very cold fingers and toes.
• Ginkgo is also very effective in improving mental health in patients with cerebral vascular insufficiency,
  working not only by increasing blood flow to the brain, but also by enhancing energy production within the brain, increasing the uptake of glucose by brain cells and even improving the transmission of nerve signals (memory is directly related to the speed at which the nerve impulse can be transmitted).
• Although most people report benefits within 2–3 weeks, Ginkgo should be taken for at least 12 weeks
  in order to determine effectiveness. The longer Ginkgo is taken, the more obvious and lasting its benefits.

 

Drug–herb interaction cautions
Ginkgo biloba:

• Plus aspirin: may induce spontaneous bleeding when combined with chronic use of aspirin. Increased bleeding potential reported after Ginkgo biloba usage in a chronic user (2 years) of aspirin.

Physical medicine

• Regular exercise: a minimum of 30 min, four times a week; 3–4 hours per week is recommended:
• Impaired endorphin activity within the hypothalamus is a major factor in provoking hot flashes. Regular exercise increases the production and secretion of endorphins thus reducing the frequency and severity of hot flashes:
• Endorphins, the body’s internally produced mood-elevating and pain-relieving compounds, reduce hot flashes via their effects on the functioning of the hypothalamus.
• Located in the center of the brain, the hypothalamus serves as the bridge between the nervous system and the endocrine (hormonal) system, and controls many body functions including body temperature, metabolic rate, sleep patterns, libido, reactions to stress, mood, and the release of pituitary hormones including FSH, the hormone whose excessive secretion results in hot flashes.
• In a study in Sweden of 79 postmenopausal women who took part in a regular exercise program, those who exercised an average of 3.5 hours per week experienced no hot flashes. Similar results have been reported in other studies of women both on and off HRT.
• Regular exercise provides numerous other benefits including: decreased blood cholesterol levels; decreased bone loss; improved ability to deal with stress; improved circulation; improved heart function;
  improved oxygen and nutrient utilization in all tissues; increased endurance and energy levels; increased self-esteem, mood and frame of mind; and reduced blood pressure.

ICIM Medics Approach

If you feel that this article relates to you and you suspect that are experiencing difficulties going through Menopause then please make an appointment for the Female Hormone Assessment : http://icimmedics.com/medical-assessments/female-hormone-assessment/

The results from the assessment can be used by one of our Natural Medical Practitioners who will help you with your individualised treatment plan. This may include dietary, nutritional and/or botanical advice.

This article is not meant to be used for treatment but for information purposes only. If you feel that this approach is appropriate for you please contact ICIM Medics on 045 844 819 or www.icim.ie e-mail : info@icim.ie  Both appointments can be arranged for you.

Tags: Hot Flushes, Menopause, Ovaries, Period