Menopause

Menopause represents the end of menstruation. While technically it refers to the final menstrual period, it is not an abrupt event, but a gradual process. Menopause is not a disease that needs to be cured, but a natural lifestage transition. However, women have to make important decisions about managing its symptoms, including the use of hormone replacement therapy (HRT).

Many women have irregular periods and other problems of perimenopause for years. It is not easy to predict when menopause begins, although doctors agree it is complete when a woman has not had a period for a full year.

Eight out of every 100 women stop menstruating before age 40. At the other end of the spectrum, five out of every 100 continue to have periods until they are almost 60. The average age of menopause is 51.

There is no method to determine when the ovaries will begin to scale back but a woman can get a general idea based on her family history, body type, and lifestyle. Women who began menstruating early will not necessarily stop having periods early. A woman will likely enter menopause at about the same age as her mother.

Causes and Symptoms

Once a woman enters puberty, each month her body releases one of the more than 400,000 eggs that are stored in her ovaries, and the lining of the womb (uterus) thickens in anticipation of receiving a fertilized egg. If the egg is not fertilized, progesterone levels drop and the uterine lining sheds and bleeds.

By the time a woman reaches her late 30s or 40s, her ovaries begin to produce less estrogen and progesterone and release eggs less often. The gradual decline of estrogen causes a wide variety of changes in tissues that respond to estrogen—including the vagina, vulva, uterus, bladder, urethra, breasts, bones, heart, blood vessels, brain, skin, hair, and mucous membranes. Over the long term, the lack of estrogen can make a woman more vulnerable to osteoporosis (which can begin in the 40s) and heart disease.

As the levels of hormones fluctuate, the menstrual cycle begins to change. Some women may have longer periods with heavy flow followed by shorter cycles and very little bleeding. Others will begin to miss periods completely. During this time, a woman also becomes less able to get pregnant.

The most common symptom of menopause is a change in the menstrual cycle, but there are various other symptoms as well, including:
  • hot flashes
  • night sweats
  • insomnia
  • mood swings/irritability
  • memory or concentration problems
  • vaginal dryness
  • heavy bleeding
  • fatigue
  • depression
  • hair changes
  • headaches
  • heart palpitations
  • sexual disinterest
  • urinary changes
  • weight gain

 Diagnosis

The clearest indication of menopause is the absence of a period for one full year. It is also possible to diagnose menopause by testing hormone levels. If it has been at least three months since a woman’s last period, a follicle-stimulating hormone (FSH) test might be helpful in determining whether menopause has occurred.

FSH levels rise steadily as a woman ages. The FSH test alone cannot be used as proof that a woman has entered early menopause. A better measure of menopause is to determine the levels of FSH, estrogen, progesterone, testosterone, and other hormones.

Treatment

Some women also report success in using natural remedies to treat the unpleasant symptoms of menopause. Not all women need estrogen and some women cannot take it due to adverse side effects.

Many doctors do not want to give hormones to women who are still having their periods, however erratically. Only a third of menopausal women in the United States try HRT and of those who do, eventually half of them drop the therapy. As for alternative therapies, most have only received attention in the United States in the past decade or so.

Debate continues until scientific studies can prove these treatments’ effectiveness on menopausal symptoms. As interest in alternative therapies for menopause continues, so will research. In the meantime, women should consult their physicians when adding alternative therapies to treatment of menopause symptoms.

General dietary recommendations include raw foods, fruits, fresh vegetables, whole grains, nuts, seeds, and fresh vegetable juices. Some foods are recommended because they contain phytoestrogens. Intake of dairy products and meats should be reduced. Pork and lunch meats should be avoided.

Herbs

Herbs have been used to relieve menopausal symptoms for centuries. Women who choose to take herbs for menopausal symptoms should learn as much as possible about herbs and work with a qualified practitioner (an herbalist, a traditional Chinese doctor, or a naturopathic physician).

The following list of herbs include those that herbalists recommend to treat menopausal symptoms:
  • black cohosh (Cimicifuga racemosa): shown to reduce hot flashes, other menstrual complaints at a recommended dose of 20 mg twice daily
  • black currant: breast tenderness
  • chaste tree/chasteberry (Vitex agnus-castus): hot flashes, excessive menstrual bleeding, moodiness
  • chickweed (Stellaria media): hot flashes
  • evening primrose oil (Oenothera biennis): mood swings, irritability, breast tenderness
  • fennel (Foeniculum vulgare): hot flashes, digestive gas, bloating
  • flaxseed (linseed): excessive menstrual bleeding, breast tenderness, and other symptoms, including dry skin and vaginal dryness
  • ginkgo (Ginkgo biloba): memory problems
  • ginseng (Panax ginseng): hot flashes, fatigue, vaginal thinning
  • hawthorn (Crataegus laevigata): memory problems, fuzzy thinking
  • horsetail (Equisetum arvense): osteoporosis
  • lady’s mantle: excessive menstrual bleeding
  • Licorice (Glycyrrhiza glabra) root: general menopausal symptoms
  • Mexican wild yam (Dioscorea villosa) root: vaginal dryness, hot flashes, general menopause symptoms
  • motherwort (Leonurus cardiaca): night sweats, hot flashes
  • oat (Avena sativa) straw: mood swings, anxiety
  • passionflower (Passiflora incarnata): insomnia, pain
  • raspberry leaf: normalizes hormonal system
  • sage (Salvia officinalis): mood swings, headaches, night sweats
  • skullcap (Scutellaria lateriflora): insomnia
  • sesame oil: vaginal dryness (applied topically)
  • valerian (Valeriana officinalis): insomnia
  • violet (Viola odorata): hot flashes.

Phytoestrogens

Proponents of plant estrogens (including soy products) believe that phytoestrogens are better than synthetic estrogen, but this has not been proven. The results of small preliminary trials suggest that the estrogen compounds in soy products can relieve the severity of hot flashes and lower cholesterol. It has not been proven that soy can provide all the benefits of synthetic estrogen without its negative effects.

Women in other countries who eat foods high in plant estrogens (especially soy products) have lower rates of breast cancer and report fewer symptoms of menopause. While up to 80% of menopausal women in the United States complain of hot flashes, night sweats, and vaginal dryness, only 15% of Japanese women have similar complaints.

When all other things are equal, a soy-based diet may make a difference (and soy is very high in plant estrogens). One study showed positive effects from soy, but they only lasted about six weeks.

Several studies have shown that a black cohosh extract (Remifemin) relieved menopausal symptoms as well as or better than estrogen and that it showed the greatest promise among alternative treatments. Side effects were rare. Flaxseeds also are a good source of phytoestrogens.

Other sources include red clover leaf, licorice, wild yam, chick peas, pinto beans, french beans, lima beans, and pomegranates. In 2003, red clover leaf was thought to offer relief for hot flashes, but in two short clinical trials, it failed to demonstrate hot flash relief.

Herbal practitioners recommend a dose based on a woman’s history, body size, lifestyle, diet, and reported symptoms. In one study at Bowman-Gray Medical School in North Carolina, women were able to ease their symptoms by eating a large amount of fruits, vegetables, and whole grains, together with 4 oz of tofu four times a week.

Many women think that natural or plant-based means harmless. In large doses, phytoestrogens can promote the abnormal growth of cells in the uterine lining. Unopposed estrogen of any type can lead to endometrial cancer. However, a plant-based progesterone product sometimes can be effective alone, without estrogen, in assisting the menopausal woman in rebalancing her hormonal action throughout this transition time.

Homeopathy

Homeopathic remedies for menopausal symptoms have been clinically successful. For best results, the patient should consult a homeopathic physician. However, the following remedies can be tried to alleviate specific groups of symptoms:
  • lachesis: hot flashes, irritability, talkativeness, tightness around abdomen, dizziness, fainting
  • sepia: bleeding between periods, chilliness, tearfulness, withdrawal from loved ones, sinking feeling in stomach
  • pulsatilla: tearfulness, thirstless, feels better with others, avoids heat, hot flashes, varicose veins, hemorrhoids
  • sulfur: philosophical personality, feeling hot, itching and burning of vagina and rectum
  • lycopodium: low self esteem, bloated after eating, infrequent menstruation, low blood sugar, weak digestion, belching
  • Argentum nitricum: gas, indigestion, craving for sweets and chocolate, panic attacks, fear of crossing bridges
  • Magnesium phosphoricum: severe cramping
  • transitional formula: hot flashes, night sweats, insomnia, skin-crawling sensation
  • women’s formula: perimenopause, PMS, irregular cycles, infertility, absent or excessive bleeding, menopausal discomfort
  • vital formula: anxiety, headaches, palpitations, PMS, mood swings

Yoga

Many women find that yoga can ease menopausal symptoms. Yoga focuses on helping women unite the mind, body, and spirit to create balance. Because yoga has been shown to balance the endocrine system, some experts believe it may affect hormone-related problems.

Studies have found that yoga can reduce stress, improve mood, boost a sluggish metabolism, and slow the heart rate. Specific yoga positions deal with particular problems, such as hot flashes, mood swings, vaginal and urinary problems, and other pains.

Exercise

Exercise helps ease hot flashes by lowering the amount of circulating FSH and LH and by raising endorphin levels (which drop during a hot flash). Even exercising 20 minutes three times a week can significantly reduce hot flashes. Weight bearing exercises help to prevent osteoporosis.

Elimination

Regular, daily bowel movements to eliminate waste products from the body can be crucial in maintaining balance through menopause. The bowels are where circulating hormones are gathered and eliminated, keeping the body from recycling them and causing an imbalance.

Acupuncture

This ancient Asian art involves placing very thin needles into different meridian points on the body to stimulate the system and unblock energy. It usually is painless and has been used for many menopausal symptoms, including insomnia, hot flashes, and irregular periods.

Acupressure and massage

Therapeutic massage involving acupressure can bring relief from a wide range of menopause symptoms by placing finger pressure at the same meridian points on the body that are used in acupuncture.

There are more than 80 different types of massage, including foot reflexology, Shiatsu massage, and Swedish massage, but they all are based on the idea that boosting the circulation of blood and lymph benefits health.

Breast massage (rubbing castor oil or olive oil on the breasts for five minutes thrice weekly) balances hormone levels, helps the uterus contract during menstruation, and prevents cramping pains.

Biofeedback

Some women have been able to control hot flashes through biofeedback, a painless technique that helps a person train her mind to control her body. A biofeedback machine provides information about body processes (such as heart rate) as the woman relaxes her body. Using this technique, it is possible to control the body’s temperature, heart rate, and breathing.

Other treatments

Therapeutic touch, an energy-based practice, may relieve menopausal symptoms. Cold compresses on the face and neck can ease hot flashes. Sound or music therapy may relieve stress and other menopausal symptoms. Prayer or meditation can help improve coping ability.

Supplementation with magnesium, calcium, vitamin D, vitamin K, boron, manganese, and phosphorous is used to prevent osteoporosis. Vitamin E supplementation may reduce hot flashes and risk of heart disease.

Allopathic treatment

When a woman enters menopause, her levels of estrogen drop and troublesome symptoms begin. Hormone replacement therapy (HRT) can suppress symptoms by boosting the estrogen levels while also providing protection against heart disease and osteoporosis (bone weakening). There are two types of hormone treatments: hormone replacement therapy (HRT) and estrogen replacement therapy (ERT).

HRT is the administration of estrogen and progesterone; ERT is the administration of estrogen alone. Only women who have had a hysterectomy (removal of the uterus) can take estrogen alone, since taking this “unopposed” estrogen can cause uterine cancer. The combination of progesterone and estrogen in HRT eliminates the risk of uterine cancer.

Experts once disagreed on whether HRT increases or decreases the risk of developing breast cancer. A Harvard study concluded that short-term use of hormones carried little risk, while HRT used for more than five years among women 55 and over seemed to increase the risk of breast cancer. In 2002, the Women’s Health Initiative (WHI) quieted much of the disagreement, particularly concerning long-term use of HRT.

Use of combined estrogen and progestin therapy was stopped in the large trial when invasive breast cancer risk hit a threshold among participants. The risks of HRT were determined to outweigh the benefits. Use of combined HRT also increased risk of coronary heart disease, stroke and even dementia.

Following the WHI, many physicians have cautioned women to discuss the benefits and risks of HRT with their doctors on an individual basis. In some cases, the benefits of short-term use of HRT still may outweigh the risks.

Women remain poor candidates for hormone replacement therapy if they:
  • have ever had breast or endometrial cancer
  • already have heart disease
  • have a close relative (mother, sister, grandmother) who died of breast cancer or have two relatives who got breast cancer before age 40
  • have had endometrial cancer
  • have had gallbladder or liver disease
  • have blood clots or phlebitis

Women would make a good candidate for HRT if they:
  • need to prevent osteoporosis
  • have had their ovaries removed
  • have significant symptoms
  • need short-term symptom relief

Aside from the findings of the WHI concerning risks of HRT, side effects of treatment include bloating, breakthrough bleeding, headaches, vaginal discharge, fluid retention, swollen breasts, or nausea.

A 2001 study reported that HRT might worsen asthma in postmenopausal women who had asthma prior to menopause. Some side effects can be lessened or prevented by changing the HRT regimen.

The decision should be made by a woman and her doctor after taking into consideration her medical history and situation. Women who choose to take hormones should have an annual mammogram, breast exam, and pelvic exam and should report any unusual vaginal bleeding or spotting (a sign of possible uterine cancer).

Anti-estrogens

This new type of hormone therapy offers some of the same protection against heart disease and bone loss as estrogen, but without the increased risk of breast cancer.

The best known of these anti-estrogens is raloxifene (Evista), which mimics the effects of estrogen in the bones and blood, but blocks some of its negative effects elsewhere.

It is called an anti-estrogen because for a long time these drugs had been used to counter the harmful effects of estrogen that caused breast cancer. Oddly enough, in other parts of the body these drugs mimic estrogen, protecting against heart disease and osteoporosis without putting a woman at risk for breast cancer.

Testosterone replacement

The ovaries also produce a small amount of male hormones (about 300 micrograms), which decrease slightly as a woman enters menopause. Most women never need testosterone replacement.

Testosterone can improve the libido, and decrease anxiety and depression; adding testosterone is especially beneficial to women who have had hysterectomies. Testosterone also eases breast tenderness and helps prevent bone loss. Side effects include mild acne and some facial hair growth.

Birth control pills

Women who are still having periods but who have annoying menopausal symptoms may take low-dose birth control pills to ease the problems; this treatment has been approved by the FDA for perimenopausal symptoms in women under age 55. HRT uses lower doses of estrogen, however.

Expected results

Menopause is a natural condition of aging. Some women have no problems with menopause, while others notice significant unpleasant symptoms. Results of allopathic and alternative treatments vary from one woman to another.

Prevention

Menopause can’t be prevented, though some of the symptoms can be relieved by the treatments listed above.

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