June Russell's Health Facts

Menopause

[Introduction] [Natural Approaches] [HRT] [HRT Strategies] [The Women's Health Initiative Studies] [Related Links]

Introduction

Menopause is the cessation of the monthly female menstrual cycle, usually in the late forties or early fifties, and it marks the end of fertility. Currently, about 40 million American women are menopausal, and the number will grow dramatically in the next decade as the baby-boomer generation reaches the age of menopause. At the turn of the last century, menopause and death occurred at roughly the same ages, but now the average woman who reaches menopause will live 30 more years. Menopause is the cessation of ovulation; that is, the ovaries no longer release eggs and no longer secrete estrogen and progesterone. The average age for menopause is 51, and perimenopause, the transition from regular functioning of the ovaries to its absence, can take from one to ten years.

For many women menopause brings relief from monthly periods, freedom from unplanned pregnancy, and excitement about entering a new phase of life: for others menopause brings physical and emotional upheaval. Some of the symptoms of menopause may include insomnia, depression, stiff joints, bloating, vaginal dryness, sore breasts, hot flashes and night sweats, changes in mood and sexual desire, a decrease in memory or concentration, and changes in body, scalp hair or skin tone. Hot flashes, which are characterized by a sudden increase in heart rate, peripheral blood flow, and sweating, are for many women the most uncomfortable aspect of menopause, and about four to five million women currently are severely affected by hot flashes.

The National Institute on Aging says menopausal women are at a higher risk of developing six chronic health conditions: diabetes, heart trouble, osteoporosis, cancer, hypertension (high blood pressure) and arthritis; hypertension and arthritis being the most common. Women who have had surgically-induced menopause report a strikingly higher frequency of all conditions. The American Association of Clinical Endocrinologists (AACE) caution that there are millions of American women with menopausal-like symptoms who may actually be suffering from undiagnosed thyroid disorders, and although depression is common in both menopausal and premenopausal women, it is not scientifically linked to menopause.

One of the fears of women about menopause is weight gain, and although many women do gain, lifestyle choices play a big role. A recent study in the journal Menopause, found that menopausal women who participated in healthful eating and regular exercise were much less likely to gain weight, but the body has a tendency to deposit fat around the waist as estrogen levels fall, so clothing could feel tighter even though a woman’s weight may not change.

For the past several decades, conventional medicine has treated menopausal discomforts with estrogen therapy (ERT), or estrogen and progestin (HRT) replacement therapy. Studies now show that estrogen increases the risk of cancer, blood clots, gall bladder disease, and insulin resistance, and many choose to forego ERT because of the resulting cyclical bleeding, and reduced cognitive decline in older women. Progestin (synthetic progesterone) also has unwanted and hazardous effects. There are physicians who can prescribe natural hormones, which are identical to human hormones, and safer to use. Ideally your health care practitioner should monitor your salivary hormone levels and tailor the dosage to fit individual needs, says Shari Lieberman, PhD, a professor at the University of Bridgeport School of Human Nutrition in Connecticut.

Natural Approaches for Treating Symptoms

There are many natural approaches that may help with the symptoms of menopause:

Shifting from a diet high in meat and dairy products to more of a vegetable diet;
Because of differing reports as to the effectiveness and safety of soy, black cohosh (over-the-counter “Remifemin”) is recommended for menopausal (and PMS) symptoms. Because of a lack of long-term studies it is recommended that “Remifemin” not be taken for more than six consecutive months, and used with caution in individuals with high blood pressure or those on HRT, but avoided by those who are pregnant or breast feeding, says the American Cancer Society (2002).
To avoid vaginal dryness, drink plenty of water, avoid alcohol and caffeine and take 500 mg twice a day of an essential fatty acid supplement like borage or primrose oil to moisturize tissues. Taking 800 IU's daily of vitamin E can help with hot flashes as well as vaginal dryness, but check with your doctor about this amount if you have high blood pressure, diabetes or breast cancer. Vitamin E can also be applied topically to vaginal area for the relief of dryness.
St. Johnswort at 300 mg three times a day can be helpful, but check with your doctor if you are taking any other medications.
Alcohol can intensify almost every type of menopausal symptom, and hot flashes are most severe after stress or alcohol consumption. Even moderate alcohol use may increase estrogen levels in postmenopausal women receiving HRT, potentially affecting their risk for various adverse health effects.
Acupuncture, homeopathy, yoga, Traditional Chinese Medicine, meditation, and relaxation techniques have been reported to be helpful to relieve menopausal symptoms.

HRT/Natural Hormone Replacement

Everywhere there are media reports of the dangers of synthetic HRT (hormone replacement therapy), yet many postmenopausal women are not aware of ‘natural hormone therapy,’ - or more accurately, ‘bio-identical therapy’ which is now offered as a safer choice. Because of the many dangers, women’s health experts, such as Dr. Christiane Northrup, MD, are advising women who are on the synthetic HRT to switch to natural hormones.

‘Bio-identical’ indicates that these hormones are identical chemically and structurally to those hormones produced by the human body, and although they are associated with some potential risks and side effects, the risk is minimized. To clarify further: a molecule is extracted from either soy or yam, and through a series of chemical processes it is converted to the specific human hormone molecule. There is no trace of the plant in the final product, just pure bio-identical human hormone. Balancing the estrogens with a bio-identical progesterone also helps offset the risks. Postmenopausal women need to know there are other choices and that there are physicians who can customize the dose according to a woman’s individual needs.
{Janice Unertl, RPh Women’s International Pharmacy (800-279-5708) email: pharmacist@womensinternational.com}

HRT Strategies

We are discovering that HRT is really best for short term treatment of menopausal symptoms, and its role in disease prevention is no longer clear. We have emerging science on black cohosh as a potential aid for menopausal symptoms, and the most popular brand is Remifemin, which can be found in any drug store. All herbals take 2-3 weeks to reach the full effect, so be patient. You can try sage tea or valerian for insomnia (found in Celestial Seasonings' Sleepy Time Tea). St. Johnswort has been used for mood swings, but black cohosh seems to work as well.

The lowest dose of either estrogen or progesterone is the best way to go, and everyone needs to keep in mind that the best way to go is to get aggressive about leading a healthy lifestyle. Nothing works if you are sedentary, stressed out of your mind and eating junk all day. Science has clearly shown that getting physical, eating well and practicing stress resilience will cut symptoms of menopause by at least 50%.
{Dr. Peeke’s e-mail newsletter, Volume 3, Issue 24, July 30, 2002}

Women taking natural progesterone have far less bleeding than women taking a synthetic version of the same hormone, says new research in the November 2002, Journal of Obstetrics and Gynecology. Micronized progesterone (MP) is really the same hormone as a woman makes herself before menopause. It is chemically identical in all respects. The synthetic version of the hormone is 35 times stronger than natural progesterone, and nullifies the beneficial effects provided by the estrogen.
{healthscout.com, Nov. 2002}

The Women's Health Initiative Studies

The first Women’s Health Initiative (WHI) studies (2003) on the risks of hormone replacement (HRT), and newer studies that regularly appear, all add to the impression that synthetic HRT is dangerous to your health. Over 13 million women were on some form of HRT before the initial studies were published. Millions quit cold turkey and saw their symptoms rebound. Millions stayed on HRT but live in fear of the consequences, and millions of women have been moved onto antidepressants as pharmaceutical companies have campaigned to position those drugs as substitute products — even though most of these women are not depressed and are thereby exposed to a new set of potential side effects.

In the light of the studies, all HRT is bad and no one should use it, yet note that the studies published to date all concern synthetic HRT, specifically Premarin and Prempro. They say nothing about bio-identical hormones. Also, the women in the WHI studies were on HRT after menopause, which is most often unnecessary therapeutically and obviously unnatural. The most common use of HRT is for per menopausal symptoms, so we can’t say the WHI studies really predict the health risks for women in their 40’s who are the typical users of synthetic HRT.

There is a mountain of evidence indicting synthetic HRT. Alternative practitioners recognized the problems with synthetic hormones for many years because of the dozens of studies documenting the adverse health risks. The WHI indicated that the increase for the relative risk for breast cancer was 26%; for heart attack, 29%; for stroke, 41%; for blood clots 100%; for Alzheimer’s or dementia, over 100%.

Most women don’t even require hormone therapy, and there are good alternatives such as bio-identical hormones, found naturally in the human female body, for which there are no known health risks.
{“Perspective on the risks of hormone replacement therapy (HRT),” by Marcelle Pick, OB/GYN Nurse Practitioner, at Women to Women, on women issues.about.com, Sep. 2004}