Menopause

Kate Mack Nutrition Educator September 20, 2002 MENOPAUSE

There are more than 35 million women going through Menopause in the United States today. Eighty percent of those women will seek some form of treatment for their symptoms this year. In my paper I explore how our society has handled this condition and why there are so many opinions out there. A woman needs to be well informed to make an educated quess on what path she will take in dealing with Menopause. My goal is for women to come away with an awareness that diet, lifestyle, herbs and supplements can help them treat their symptoms.

I turned 50 this last year. It has truly been an eye opener both physically and emotionally. Although most women hit menopause in their early 50’s I started experiencing symptoms shortly after the birth of my second child at age 40. By the time I was 46 I had tried several different treatments. I experienced every symptom known and it wasn’t getting any better. I was depressed, tired all the time, not sleeping and having hot flashes about 8 times a day. My joints started to hurt. Every doctor I saw wanted me to go on Hormone Replacement Therapy or HRT. I did not want to . However at 46, after a densitometry test revealed that I had poor bone mass, I started Prempro. Prempro is a combination of progestin and estrogen produced from pregnant mare urine. On the second day I felt 50% better and by the third day I was myself. After 6 years of trying numerous treatments to deal with my Menopause I had managed to find relief.

That’s not the end of the story. At 49 I was diagnosed with Uterine Cancer. So I began to wonder if the solution I chose for my Menopausal symptoms was the cause of my cancer. I also wonder if there are safer and better treatments to deal with Menopause. In my paper I explore different Menopausal therapies and I look at the controversy surrounding some treatments being used.

WHAT DOES MENOPAUSE MEAN?

Menopause refers to the cessation of menses or periods. The term derives from the Greek word meno (month, menses) and pauses (pause). This natural process is also known to many women as the “change of life” or “the change”. Throughout history Menopause was viewed by many cultures to be influenced by the moon. The moon may or may not affect our periods but hormones certainly do. Light affects pineal production of melatonin which has a major impact on sex hormones. The years surrounding menopause and encompassing the gradual change in ovarian function constitute an entire stage of a woman’s life. This stage can last anywhere from six to thirteen years and is known as the climacteric. (Northrup, 2001 105) The average age of menopause for American women is 52. However some women can experience symptoms as early as their late 30’s. Clinically the term Menopause is used for a woman that has not had a period for one year. The period of time prior to menopause is called Perimenopause. During this period a women starts to miss periods and starts to experience symptoms of Menopause.

With the increase in longevity, most women will still have a third of their lives to live after their periods have stopped. Dr. Christiane Northrup expresses it best in her book, Women’s Bodies, Women’s Wisdom. She feels that our bodies are not “shutting down” but going through a normal physiological process. It is a period of deep discovery and self-exploration. A woman needs to take stock of her present condition emotionally and physically and create a healthy body and mind to last her until the end of her life.

SO WHY DOES MENOPAUSE HAPPEN?

The woman’s cycle

During a women’s cycle, the time between menses and ovulation is known as the follicular phase when an egg grows and develops. Ovulation, which occurs at midcycle, is accompanied by an abrupt rise in the neuropeptides FSH(follicle stimulating hormone) and LH(luteinizing hormone). FSH is a hormone that stimulates the ovaries to secrete estrogen, the sex hormone that stimulates development of breast, uterine and ovarian tissue. . When this estrogen reaches a certain level it signals the hypothalamus to trigger the pituitary to secrete luteinizing hormone (LH)). (Northrup 2001 46-67)

Once the level of LH rises and peaks the estrogen levels fall. (Around day 14 of a 28-day cycle). This stimulates ovulation, the release of an egg from its ovarian follicle. After ovulation the follicle (now called the corpus luteum) is filled with cholesterol, which is converted first to pregnenolone and then to progesterone. This newly made progesterone is used in part for the building up of the uterine lining. If after 13 to 15 days the egg is not fertilized, the uterine lining is sloughed off (in menstruation) when both estrogen and progesterone levels drop. A women’s menstrual cycle is estrogen dominance during the first 14 days of the cycle and shifts at mid-cycle to progesterone dominance. Estrogen is not the only hormone made by the ovaries. The ovaries also make androgens such as DHEA, testosterone, and progesterone. (Borkin,2002:68)

At menopause, hormone production from the ovaries decline and a woman’s cycle becomes irregular. Both the LU and FSH are elevated and the progesterone and estrogen gradually decline to a level that does not support menstruation . A woman ceases her monthly period and her body begins to react to the lack of sex hormones.

SYMPTOMS

85% of all women will experience some level of symptoms.

The following is a list of the most common symptoms:

Hot flashes

Mood swings

Depression

Irregular periods

Disturbed sleep

Night sweats

Decreased sexual desire

Nausea

Increased bladder infections

Heart palpitations

Loss of skin elasticity

Hair loss

Vaginal atrophy

This is definitely a long list but the two most serious conditions of postmenopausal women are heart disease and osteoporosis.

HEART DISEASE AND OSTEOPOROSIS

Heart Attacks are the number one killer of woman. According to the American Heart Association, one in nine women between the ages of 45 and 64 have some form of cardiovascular disease or CVD. This number climbs to 1 in 3 after the age of 65. Since 1984, the mortality rate of women with heart disease has surpassed that of men. An estimated 40,000 more women die yearly from CVD than men. Breast cancer is a great concern and threat to many women, however breast cancer kills 43,000 women annually in comparison to 500,000 that die of heart disease. (Moran, 2002, 57-67)

Up until recently the general thought was to prescribe HRT for heart health. A study being conducted by the Women’s Health Initiative has proven that HRT does not improve heart health. I discuss this study later in my paper.

Osteoporosis is an acceleration of the thinning of the bones. Although osteoporosis is most often thought of as a postmenopausal condition it is likely that osteoporosis changes have already begun in many women before menopause. Trabecular bone loss begins slowly from the spine several years before menopause. In contrast, bone loss from the femoral neck starts at approximately age 30. (Moran, 2002: 18-28) By the time most women reach menopause they have already lost bone mass density.

Our bones continue to build mass through our twenties. The period from 15 to 22 is a major time of bone mass building. By 30 a woman has reached her bone mass peak and from this point on she will experience a gradual decline. Since bone is building from the time we are born into our 30’s, it is important to get the nutrients and exercise we need for bone health right from the start. Unfortunately, women that develop eating disorders during these crucial building years find that their bones never reach their potential peak bone mass. So when the bones start to reabsorb at Menopause they are starting with a bone mass deficiency.

Once women reach menopause they usually lose bone mass rapidly (presumably as a result of declining estrogen levels). During the first 5 years bone mass decline averages 3% to 5% per year. After age 65, bone loss is occurring at 0.5% to 1% per year. It should be pointed out that some women, as many as 20%, can lose bone mass at a rate of 10% per year during these early postmenopausal years. (National Osteoporosis Foundation, 1999) Many health practitioners feel that these menopausal problems are due in part to chronic depletion of women’s metabolic resources during the perimenopausal years. The woman’s adrenal glands and her state of general nutrition are very important. In a healthy woman, the adrenal glands will be able to gradually take over hormonal production from the ovaries. Unfortunately the majority of women approach menopause in a state of emotional and nutritional depletion that has affected optimal adrenal function. The adrenal glands are “burnt out”. Under these conditions woman require hormonal, nutritional, and emotional support until their endocrine balance is restored. (Borkin, 2000: 67-79)

THERAPIES TO DEAL WITH MENOPAUSE

So what is a woman to do? There are so many different therapies and ideas. Medically, nutritionally, herbally, emotionally and spiritually. So let’s look at some therapies that are available to use.

Estrogen Replacement Therapy

The decision to use estrogen for hormone replacement therapy is difficult. Providing relief from hot flashes as well as slowing down the rate of osteoporosis, versus the potential side effects such as increased risk of endometrial cancer and possibly an increase of breast cancer are issues a woman needs to think about. On July 9, the Woman’s Health Initiative abruptly halted a hormone replacement study because they found that the drugs caused a slight but significant increase in the risk of invasive breast cancer. Although the danger to an individual woman is tiny the drugs’ risks exceed their benefits. (San Francisco Chronicle, July 9,2001)

An estimated 6 million women take the drugs estrogen and progestin to replace the hormones lost at menopause. This is 38% of postmenopausal women. It was hoped that this study would prove that no only do the drugs relieve hot flashes, night sweats and vaginal dryness but that they improve women’s health overall. The study’s investigators reported that this did not happen. The directors of the study, known as the Women’s Health Initiative, sent letters to the study’s 16,000 participants telling them to stop taking their medications. The risk of breast cancer rose by 26% in women on the combined therapy for just over five years, while heart disease risk rose by 29% and there was a 41% increase in the risk of stroke. However, there were fewer colorectal cancers and fewer hip fractures reported. (San Francisco Chronicle, July 9,2001)

This study is a bombshell for those that once thought HRT was a way for women to remain forever young. However, the study did not address the question of estrogen alone, without progestin. The Women’s Health Initiative will continue a study of 11,000 women taking just estrogen since there is no evidence so far that the drug’s risks exceed its benefits. On July 17 there was another report on HRT. The Journal of the American Medical Association reported that in a study conducted by the National Cancer Institute 44,000 women taking estrogen alone where found to have a 60% higher risk of ovarian cancer than women who had never used estrogen. Those on the hormone therapy for 20 years or more were three times as likely to develop ovarian cancer as women who did not take it at all. (health.webmd. aol.com/condition)

So when did we discover this ”synthetic estrogen” that seems to be causing such a stir? During the 1940s and 1950s estrogen became a popular prescription for the symptoms of menopause. The book Feminine Forever, written by Robert Wilson, described in graphic detail how the lack of estrogen at menopause led inevitably to the shriveling of a woman’s body. Premain was introduced in 1949. It became the synthetic estrogen replacement hormone doctors would prescribe. By the time the 1970s arrived it became apparent that just taking estrogen alone caused the build up of the endometrial lining of the uterus, thus causing Uterine Cancer. Progestin (Provera) reduced this risk so physicians recommended a combination of both hormones. Wyeth-Ayerst maker of Prempro (an estrogen and progestin combination)) did study after study that supported estrogen’s role in keeping the cardiovascular system healthy. It was shown to lower LDL cholesterol. Since heart disease was emerging as the number 1 killer of women this made sales of Prempro hit an all-time high. (Murray, 1995: 110-111)

But once again doubts began to surface. This time multiple studies began to support an incontrovertible link between estrogen supplementation and breast cancer. This should not have been a surprise since estrogen is well known to stimulate the growth of estrogen-sensitive tissue, like that in the breast and uterus. In addition, a number of large studies challenged the heart-protection theory. Until the most recent findings from the study done by the Woman’s Health Initiative, doctors had strongly supported Prempro. However, now women and their doctor’s are left to question which is the best therapy for their symptoms of menopause.

Bioidentical Hormones

In contrast to Premarin and Provera, which are synthetic and non –bioidentical hormones, there are hormones that are exactly the same as those found in the female body. Though they are synthesized in the lab from hormone precursors found in soybeans or yams, their molecular structure is designed to be an exact match of the hormones found in the human body. They are called bioidentical (Northrup, 2001: 147-152) These bioidential hormones are consistent with our normal biochemistry. Our bodies were designed to recognize and utilize them. Prempro, on the other hand, isn’t normally found in the human female body so the metabolic breakdown of the products is biologically stronger and more active than products of bioidentical estrogens. These breakdown products from synthetic hormones can produce DNA damage that is carcinogenic in tissue. The metabolic breakdown products of bioidentical estrogens are biologically weaker, so their effects on tissue do not last as long (Northrup, 2001:139)

There is a full range of bioidentical hormones available by prescription from formulary pharmacies. The dosages can be and should be individually adjusted. A salivary hormone test measures the free hormone present in the saliva, which has been shown to be comparable to what is present in other body tissues. A test kit is sent home with printed instructions. Saliva is collected and placed into provided containers at one or more specific times of the day then sent to the laboratory. This will test for estrogen, progesterone, and testosterone levels. Then a formulary pharmacy will create an individualized lotion, cream, or other base to apply to the skin. (See Resources for formulary pharmacies: Northrup, 2001: 545) Estrogen

There are three distinct estrogenic compounds produced naturally in the body: estriol, estrone, and estradiol, Estriol reaches it’s highest level during pregnancy. It has weaker biological effects on breast and uterine tissue than do estrone and estradiol. Supplemental estriol is known to be particularly effective in urogenital symptoms. It can be applied locally in the vagina and relieve urinary and vaginal conditions associated with the thinning of these tissues.

Estrone becomes the predominant estrogen after menopause. It is thought that estrone has an ability to protect heart and brain function and bone strength. It comes from women’s fat cells and does not appear to have a high cancer risk (Northrup, 2001:142-171).

Estradiol is made in the ovaries and prior to menopause plays a major role in stimulating growth in the breasts, ovaries, and uterus. It is interesting to note that after menopause the ovaries can continue to produce small amounts of estradiol, as do the secondary hormone-producing sites, such as the adrenal gland and fat cells. As a result, it is biologically possible for a woman to produce enough of her own estrogen to support optimal health throughout the second half of her life (Northrup, 2001: 154) Estradiol is more likely to be breast cancer inducing. But given in the bioidentical form it is weaker. Estradiol is the most common form of estrogen given in hormone replacement. Although some health providers believe a combination of all three estrogens should be given, other doctors believe that if women can get good results from Estradiol then why give addition estrogen.

Progesterone

The decline in progesterone is the first hormonal change to cause symptoms in a women approaching menopause. Progesterone comes primarily from the ovaries before and after menopause, but it is also made both in the brain and the peripheral nerves. It seems to eliminate many menopausal symptoms. It has a relatively unique ability to be converted into other hormones as needed. (E.g. cortisone, testosterone and estrogen.). It can be metabolized into other hormones such as testosterone, and estrogen. Because of this it is thought that a woman can get relief from her symptoms during early perimenopause if she uses a natural progesterone cream. John R. Lee, M.D., the Northern California physician who pioneered the study of natural or bioidentical progesterone in women after menopause, recommends ¼ teaspoon a day of progesterone cream (Wright, 1997:65)

From recent studies we are aware that synthetic progesterone can increase the risk of breast cancer. But we don’t know the effect of bio-identical progesterone on breast cancer. Studies need to be done using both bioidentical estrogen and bioidentical progesterone. Pharmaceutical companies generally finance most drug research. However Bioidentical estrogen and progesterone cannot be patented so there has been a lack of interest to fund research on these hormones. On the other hand Pharmaceutical companies can patent the mode of transportation used to get the hormone into the body such as transdermal patches, vaginal rings and vaginal estrogen creams. So maybe drug companies will increase research on these bio-identical hormones (Wright, 1997: 44-45)

SUPPORT OF MENOPAUSAL SYMPTOMS

Stress Reduction

Perhaps the single most important factor in the health of each of us is how we deal with our stress. Stress affects us down to the smallest molecule in our bodies. We all seem to live busy lives and forget how important it is to slow down and take care of our emotional being. Stress can cause depression, insomnia, eating disorders, skin problems, low self-esteem, heart disease, chronic pain and even death. We know that when we stay in a stressed state of mind our adrenal glands begin to wear out. It is like a car that is always left to idle and never turned off. Eventually the car falls apart due to the constant wear and tear. Our bodies respond in the same way. At some point our bodies give out and we end up in a diseased state. Our adrenal glands become over burdened and are unable to function properly thus leaving us in an imbalanced hormonal state. This in turn affects every metabolic process in our bodies.

Find ways to connect to yourself, whether it is through meditation, prayer, yoga or seeking help from a therapist. Deep breathing is very beneficial. Give yourself the permission to rest and relax. It is important to evaluate what is most important to you and your well-being. Decide what your priorities are and listen to your intuition, your inner self.

Exercise

Exercise is beneficial to both the body and the mind. It decreases stress and anxiety, helps control weight, elevates ones mood, reduces risk of heart disease and stroke, builds strength and helps maintain bones. Exercise improves sleep, boosts the immune system and boosts self-confidence. There is no doubt that exercise is also at the top of the list for prevention of menopausal symptoms. Some women that get regular exercise have been able to keep their symptoms to a minimum. There is no doubt that weight bearing exercise helps maintain and build bone. Exercise can stimulate endorphins in the brain (hypothalamus), which decreases depression. Exercise will lower your blood pressure, lower blood sugar levels and improve insulin sensitivity.

New studies and research have proven that your health can benefit from low to moderate physical activity for a total of 30 minutes on most days. The good thing about this is that you can accumulate exercise minutes throughout the day. Three 10-minute workout sessions a day do just as much good as one 30-minute workout. This is something every woman may feel that she can accomplish. (Moran, 2002: 71-72)

Acupuncture and Therapeutic touch Any kind of manual healing can be helpful with menopause symptoms. For that matter, just about any medical problem can be aided when a form of touch is involved.

DIETARY RECOMENDATIONS

Phytoestrogens are the natural hormones found in plants. These are different from the hormones found in the female body, although they may have somewhat similar beneficial effects. Phytoestrogens are found in more than three hundred plants. Soy and flaxseed are particularly rich in these substances. Phytoestrogens can be divided into two main families: isoflavones, such as genistein, daidzein, equol, and coumestrol and the Lignans, which include matairesinol, enterolactone, and enterodiol (Jack, 1999: 128,161,180,220)

They can act as antioxidants and prevent the free –radical damage to cells which in turn prevents abnormal cell growth.

Like other estrogens, phytoestrogens bind to estrogen receptors throughout our systems. They have a balancing effect. This means that if your estrogen levels are low, the plant will have a mild estrogenic effect, but if your estrogen levels are too high, they will block the stronger estrogens.

According to Christine Northrup in her book The Wisdom of Menopause, phytoestrogens do not stimulate the growth of estrogen-sensitive tissue such as in the breast and uterus. In fact, they have been shown to inhibit breast tumors in some animal studies. She feels that menopausal herbs are an excellent choice for those who are concerned about cancer. Some Alternative therapy experts have a different view. Health Magazine (March 2002) states that hundreds of studies on phtoestrogens have turned up conflicting results on the benefits of these plants. The best advice is to use in moderation.

SOY

Is Soy the answer to estrogen replacement? Soy has been around for a long time. In the 60’s it was the “hippie food”. By the 90’s it had become a dominant part of the standard American diet. Soy is particularly rich in phytoestrogens,active estrogen-like substances, specifically the isoflavones and phytosterols of soybeans. They produce a mild estrogenic effect. One cup of soybeans provides approximately 300 mg of isoflavone. One research paper stated that this level is equal to one tablet of Premarin. (Carson, The Pacific Sun, 2002). I was unable to substantiate this, but it certainly makes me want to be cautious with this food.

A number of soy researchers have started to rethink how Americans eat soy. With the philosophy of “more is better” Americans have been over consuming this nutrient. The Asian diet does not center on soy. Approximately 65% of the Japanese calorie intake comes from fish, while in China the same percentage comes from pork. They ferment their soy for a long time, six months to three years and then eat it as a condiment and not as a replacement for animal foods. They use an average of 2 teaspoons a day in China and up to a quarter cup in some parts of Japan This is not a huge amount. (Carson, The Pacific Sun, 2002)

It appears that soy can have powerful effects both positive and negative. It should be eaten in moderation. Consuming between 30 and 40 milligrams each day (about as much as the Japanese get) is probably a good recommendation, and most likely that’s more than you’re eating now. (Smith, 2002: 58-65)

FLAXSEED

Flaxseed is one the best available sources of anti-cancer and phytoestrogenic compounds known as lignans. Lignans are plant substances that are broken down by intestinal bacteria into two chemicals, enterodiol and enterolactone. These substances circulate through the liver and are later excreted in the urine. Flaxseed is an excellent source of fiber and of omega-3 fats. They have potent anti-cancer effects and have the ability to modulate the action of the hormones produced in our bodies. They are potent phytoestrogens. In studies it has been shown that Flaxseed can alter estradiol levels. (Jack, 1999:110,112,116)

Lingans are good antioxidants. They have antiviral, antibacterial, and antioxidant properties. They help prevent free-radical damage to tissues. Lignans help protect the cardiovascular system by lowering LDL cholesterol and raising HDL cholesterol.

Flaxseed or oil is an excellent nutritional supplement and adding 2 Tablespoons a day to your diet can be very beneficial (Norhtrup, 2001:186)

FOLLOW A HORMONE-BALANCING FOOD PLAN

Putting together a diet that supports the “Change in life” can be beneficial. It is important to limit fatty dairy products and meats, especially beef and pork that are high in hormone disrupting chemicals. Avoid simple sugars. Do not eat fried foods and avoid rancid and hydrogenated fats, which are found in fried foods at restaurants and snack foods like potatoe chips and crackers.

Cold water fish like salmon and tuna contain EFA’s so can lower risk of heart disease. Spicy foods tend to increase hot flashes so avoid them. Try to balance estrogen levels by adding boron-containing foods like green leafy vegetables, fruits, nuts, and legumes.

Eat calcium-rich foods like vegetables, almonds, and organic dairy for bone strength. Carbonated drinks deplete the body’s stores of calcium because of high phosphorus levels so avoid them.

As an over view, eat foods that are high fiber, seasonal and organic. Include pro-biotics such as organic yogurts and calcium rich foods like broccoli and dark green vegetables. Try to include a small amount of lean organic protein at every meal, and introduce “green” foods such as sea vegetables (seaweeds) into your diet. Edible seaweeds are among the most important foods in traditional cuisines. They are high in minerals, vitamins, and complex carbohydrates. They aid digestion, benefit the heart and circulatory system, and have a stabilizing effect on the nervous system (Jack, 1999:234)

DRINK GREEN TEA

Herbs and teas are loaded with minerals and excellent for defense against Menopausal symptoms. Tea is also rich in flavonoids, antioxidant compounds that improve bone density,lower heart disease and help prevent cancer.

CUT BACK OR ELIMINATE ALCOHOL

Alcohol significantly interferes with estrogen metabolism and causes an almost immediate hormonal imbalance, with too much estrogen in the blood relative to progesterone.

Caffeine, like stress, results in the overproduction of cortisol and epinephrine, stress hormones that also favor inflammation.

SUPPLEMENTS

Probably the first line of action in taking supplements is to find a good multi-vitamin. In addition to a multi-vitamin additional vitamins and minerals may be advised. The following vitamins and minerals are very beneficial for Menopausal women.

Vitamin E

Clinical studies have demonstrated that vitamin E is effective in relieving hot flashes and menopausal vaginal complaints. It is important for fatigue. It is recommended that vitamin E be taken at a daily dose of 400 to 800 mg a day.(d-alpha-tocopherol is preferred)

Vitamin B Complex

Using B Vitamins can improve your ability to handle stress, grief and depression. They also are very important for hot flashes. Fatigue can be treated with the B complexes. 50mg a day is recommended.

Calcium

This mineral is important for bone health and helps relieve anxiety. It is also used as a sleep aid. Recommended dosage is up to 1500mg a day depending on our age. Citrate is preferred to carbonate.

Magnesium

Magnesium is very important for bone health and works with Calcium. It is also very helpful with sore joints and muscles. The recommended dose is 500mg a day.

Hesperidin and vitamin C

Hesperidin is a flavonoid found in citrus fruit. It is known to improve vascular integrity and relieve capillary permeability. Combined with Vitamin E it may be effective in relieving hot flashes. A daily dose of 900mg of hesperidin and 100mg of Vitamin C are recommended. (Murray, 1995: 1-2)

Gamma-oryzanol

Gamma-oryzanol is a growth promoting substance found in grains. Its primary action in the treatment of hot flashes is to enhance pituitary function and promote endorphin release by the hypothalamus. A number of studies have been done to document its effectiveness. 300 mg a day is recommended.

HERBS

Dong Quai (Angelica sinensis) has been called the female ginseng because of its ability to enhance energy and a sense of well-being. It also has analgesic and anti-allergy effects. (Murray, 1995:115)

Chaste Berry (Vitex agnus-castus) has a profound effect on pituitary function, which in turn shifts the production of hormones toward more progesterone and less estrogen. It helps balance irregular periods and hormonal swings. It also helps eliminate endometriosis and irregular periods. It protects against reproductive cancers and osteoporosis (Weeks, 1992:107).

Motherwort (Leonurus cardiaca) is a common weed locally grown. It lessens the severity, frequency, and duration of hot flashes. It relieves insomnia and sleep disturbances and eases stressed nerves. It can eliminate menstrual cramps and relieve uterine pain. 10-15 drops of the tincture two or three times a day is recommended (Weeks, 1992:113).

Garden Sage (Salvia officinalis) contains flavonoids and phytosterols. It has a lot of estrogenic qualities. It can help with emotional swings, ease irritated nerves, strengthen the liver, and prevent joint aches. (Weeks,1992:111)

Black Cohosh (cimicifuga racemosa) was used by the Native Americans. Black cohosh was derived from a species of buttercup. It was sold in the 1800’s for “female troubles” under the name Lydia Pinkham’s Famous Women’s Tonic. It binds to estrogen receptors and decreases hot flashes, night sweats and emotional swings. It helps digestion, relieves headaches, arthritic pain and calms the nerves. Fredi Kronenberg, PhD. says preliminary findings of studies on black cohosh at Columbia University show the herb to be safe. But he feels more research needs to be done to be 100% sure. Black cohosh is the most well documented natural alternative to hormone replacement therapy (Weeks,1992:105).

Licorice Root (Glycyrrhizin glare) includes both flavones and lignans. It has many pharmacological actions including anti-inflammatory, anti-allergy, antibacterial, and anti-cancer effects. It also helps replenish adrenal function. Licorice is believed to lower estrogen while simultaneously raising progesterone levels (Murray, 1995:115). Licorice Root is not recommended for women with high blood pressure.

Ginseng is one of the best known of all herbal medicines. It is more frequently associated with relief from hot flashes than any other herb in the west. (Weeks, 1992;115)

Dang Gui is one of the first herbs recommended for menopausal woman in the east. It is considered by many to be the finest woman’s tonic in the world. Ginseng and Dang Gui work well together (Weeks,1992:115).

St. John’s Wort is effective in treating mild to moderate depression. The usual dose is 25-30 drops of tincture twice a day until symptoms improve (Weeks,1992: 92).

Recommendation from Michael T. Murray, N.D. in Menopause:Is estrogen necessary? (Murray, 1995:116)

Dong quai 250mg Licorice root 50mg Unicom root 50mg Black cohosh 50mg Fennel 25mg False unicorn root 50mg Hesperidin bioflavonoid complex 200mg Vitamin C 100mg

There are so many herbs that can be helpful during this transitional period of a woman’s life. It can actually seem quite confusing. What is best to use and when. Pool Ridge Herbals, a company out of Guerneville, California, makes a very nice blend of herbs in a tea that supports this transition. The ingredients in this tea are Wild Yam Root, Licorice Root, Mexican Sarsaparilla, Vitex Berries, Motherwort, Blessed Thistle, Sage, Black Cohosh, Ginger Root, and Cinnamon. This is perhaps a great way to take away the guessing and get a good blend of the herbs that are helpful. If you have one particular problem you want to work on you can either go to an herbalist or an herb shop and research the best herbs to use. Susan Weed has written a very easy to use book on herbs for the menopausal years. It is called Menopausal Years; The Wise Woman Way. I strongly recommend reading this book if you choose to explore herbal treatments.

INTERVIEWS

In an effort to get an idea of what women are doing right now about Menopause I did a survey of 6 women with different backgrounds. All of them shared a desire to improve their Menopausal symptoms.

My group consisted of three women age 60, one woman 57, one woman 52 and one woman 50. On average these women started their periods around age 12 ½. All but one had experienced PMS at some point in her life. I found it interesting that those that had the worst symptoms attached to their monthly periods seemed to have the worst perimenopausal symptoms. All but the 50 year old has stopped their periods. Four women started to feel perimenopausal symptoms in their late 40’s and early 50’s. One woman had a very early menopause at age 32. Of the 5 women that have stopped their periods, three take Prempro, one takes Premarin and one does not take a hormone. The women on HRT were advised to do so by their doctors. Two of these women have taken HRT for 16 years, one for 12 years and one for 7 years. When asked none of them were aware of Bio-identical hormones. When asked what they were doing to help their symptoms, two women said they are adding Flax seed to their diets and four said they are exercising regularly.

Since the big concern about Menopause is Heart Disease and Osteoporosis I asked if there was a concern about these diseases. All 6 women said yes. Five of them had been tested for osteoporosis in the last 3 years. One woman was told to take Premarin for her heart to guard against stroke and osteoporosis. We are learning that this may be contrary to good practice. Breast cancer occurred in two families out of the six. Of the 5 women taking HRT, four wanted to stop if they could find some effective alternative and one was happy.

My take away from this study was that each situation is so unique and that each woman has her own story. I was surveying woman that started into Menopause when doctors had only one thing to give them for their symptoms. The solution was the same pill for everyone. Today we are more informed and feel more power in dealing with our health issues concerning Menopause.

Each of these women had a concern about how to deal with this change in life and a strong desire not to take HRT. The fear of breast cancer, heart disease and osteoporosis were big concerns. Out of the 5 Menopausal women only one is not taking hormones. She is 60 and from all indications she went into Menopause very healthy and physically fit. She continues to eat a healthy diet, walk regularly and stays very socially active. I suspect that if we start at an early stage building the body in a healthy way with diet, supplements and exercise that when we approach Menopause we will have an easier transition.

This paper discusses many positive options that nutrition educators can provide women facing Menopause. Nutritionists can be an invaluable resource for dietary support. There is controversy on the best way to treat Menopause. But by using alternative therapies such as herbs, working with our diets, exercising and reducing our stress we can reduce symptoms, support our hearts and strengthen our bones.


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