Menopause, Entering the Age of Wisdom

I recently read an article that began with the statement that menopause is a cultural phenomenon.  My first reaction to that statement was fury.  After I cooled down, I realized there are certain truths in the statement. Though the menopausal symptoms a woman experiences are certainly real and physical, her emotional reactions to the changes taking place in her body are colored by her culture's view of aging.  Indeed, even the severity of her physical symptoms may be strongly influenced by the diet and healing practices of her culture.

If a woman has been raised in a culture where the elders are revered as teachers and leaders of the community, then she may view menopause as a time for celebration, a time when she may cast off the responsibilities of child bearing and take her place in the community as a revered elder and teacher as she enters the age of wisdom.

A woman who has been raised in a society that glorifies eternal youth may mourn the loss of her "completeness". Her society tells her to feel imperfect or in some way inferior.  The uncomfortable physical changes she is experiencing may take on an added dimension of difficulty if they occur in an environment lacking support and understanding.

By adopting some of the dietary practices of Eastern and tribal cultures, many of the physical symptoms of menopause may be lessened or eliminated.  Many of the foods that make up a major portion of these diets contain natural plant substances that act like weak estrogens in our bodies.  They replace the dwindling supply of hormones that are being produced by the ovaries. Certain herbs also contain these substances, and may serve to ease the transition and also offer some protection against osteoporosis and heart disease, two of the natural consequences of aging.

Estrogens help to alleviate the symptoms of hot flashes, mood swings, depression and vaginal dryness experienced during the menopause. They also lower the risk of developing osteoporosis. Osteoporosis may lead to fractures and chronic back pain later in life. Estrogens are also known to lower cholesterol and to alter the lipid profile in a way that may reduce the risk of atherosclerotic heart disease and stroke.  Recent studies have shown estrogen's ability to delay the onset of Alzheimer’s symptoms and even to reduce the risk of colon cancer.

A number of plants contain substances known as phytoestrogens and isoflavones. These substances act like weak estrogens in the human body.  They have many of the same effects as endogenous hormones or synthetic hormone replacement.  Plants particularly rich in these substances include soybeans, fennel, celery, parsley, nuts, whole grains, apples and alfalfa. One cup of soy beans provides about 300 mg of isoflavone.  This would be equivalent to about 0.45 mg of conjugated estrogens  or 2/3 of the dose of Premarin given to most postmenopausal woman to protect her bones from osteoporosis.

Herbs have been used throughout the ages to treat menopausal symptoms. A list of herbs  most popularly used for the treatment of menopausal symptoms would include Dong Quai, Chaste Berry, Licorice root, Black Cohosh and Wild Yam.

Dong Quai (Angelica sinensis) is referred to in China as "Women's Ginseng" It has been used in the treatment of menstrual pain, irregular menses and menopause, especially in the treatment of hot flashes. It has a mild calming effect which may help to alleviate mood swings.  Prolonged use may exacerbate depressive symptoms in some women.

Chaste Berry exerts its beneficial effect in menopause  primarily through an alteration in pituitary function. It affects fluctuations of the hormones LH and FSH which may be responsible for vasomotor symptoms (hot flashes and flushing).

Licorice Root may help to balance the estrogen to progesterone ratio. It has been used to alleviate such symptoms as depression, craving for sweets, breast tenderness and hot flashes. Besides its estrogenic effects, licorice contains compounds that produce an aldosterone like affect which may result in severe high blood pressure with prolonged or excessive use.

Black Cohosh was widely used by Native Americans and later by American colonists for the relief of menstrual cramps, depression and menopause. It is believed to exert an estrogenic affect. The product Remifemin, a commercial formulation, is a popular natural alternative to estrogen therapy in Germany.

Wild Yam exerts primarily a progestational effect. It has been used to alleviate hot flashes.  Wild yam preparations have been shown to help reverse osteoporosis. Progestational compounds may increase vaginal dryness and depressive symptoms.

Vitamin E In the late 1940's several clinical studies found vitamin E to be effective in relieving hot flashes and vaginal  dryness compared to placebo.  The use of vitamin E may also reduce the incidence of heart disease.

Vitamin C combined with citrus bioflavenoids may be effective in reducing hot flashes.  It is also known to improve vascular integrity and relieve capillary permeability thus reducing  nose bleeds and easy bruising.

Gamma-Oryzanol is a growth promoting substance found in grains and isolated from rice bran oil.  Its action is to enhance pituitary function and to promote the release of endorphins (natural pain killers) from the pituitary gland.  It has been used to relieve hot flashes.  It has also been shown to lower cholesterol and to lower triglycerides.

Are these natural foods and supplements enough to ease a woman through the change and to protect her from the long term sequellae of estrogen deficiency most notably osteoporosis and heart disease?  When should a woman be started on hormone replacement therapy?  What are the benefits and the disadvantages of natural remedies versus hormone replacement therapy?

Traditionally, menopause is defined as one year without menstrual periods. For many physicians, this has meant that hormone replacement therapy should not be started until a woman has had no periods for one full year. Many women begin experiencing the symptoms of estrogen deficiency in the form of hot flashes, mood swings, sleep disturbances and  memory impairment months or even years before the last menstrual period.  During this time, their estrogen levels are probably high enough to support their bones and their cardiovascular systems but there is no question that the quality of their lives suffers. Alterations in diet and the use of supplements may relieve these symptoms completely or at least control them until such a time when the indication for  hormone supplements is more clear cut.

Many women experience little or no adverse reaction to synthetic hormones. There are, however, a variety of side effects reported with the use of synthetic hormones most notably breast tenderness, bloating, headaches and mood swings.  For some women, merely changing to a slightly different formulation may be enough to eliminate these problems. Others may simply not tolerate any form of hormone replacement therapy.  While the use of natural supplements or of hormones extracted from them does not guarantee the absence of these symptoms, they are reported less frequently and may be less severe than with synthetic  products.  There are also some studies that suggest that naturally occurring estrogens present less risk of inducing breast or uterine abnormalities than do synthetic hormones.

On the flip side, there is little or no standardization of dosage in most natural remedies. Wild yam grown in one region with its particular climate and soil conditions may contain a very different amount of progestational compounds than Wild Yam grown at a different location or in a different growing season.  This inconsistency makes it difficult to know how much of a given product to use or even if the same brand and preparation may be equivalent from one batch to the next. 

The preparation of synthetic hormones is strictly controlled for dosage and chemical composition.  Studies that evaluate the effects of hormone replacement depend on the use of very accurate dosages and preparations.

Should a woman choose to use natural products, I would strongly encourage her to have periodic monitoring of blood chemistries and bone mineral density to insure that she is receiving adequate protection against osteoporosis and heart disease. What ever a woman's choices, I encourage her to seek guidance from a trained health care professional.

We now live over one third of our lives after the menopause. I feel that it is important that we all take steps to preserve not only the duration but the quality of our lives.  For most women, this means estrogen replacement either in the form of diet and nutritional support or of synthetic hormone replacement.

EXERCISE is an important factor in health maintenance before and after menopause.  Weight bearing exercise,    i. e. walking at least twenty minutes per day, is important for maintaining bone health.  Aerobic exercise supports cardiovascular health, increases basal  metabolic rate and creates an over all sense of well being.

MEDITATION is a wonderful way to relax, control stress and to get in touch with yourself and the universe. I frequently hear people complain that they just don't have the time in their busy lives to meditate.  I think that the most valuable 'pearl" I received from my own meditation teacher was that you don't have to have an hour. You can meditate for a minute or two if that's all the time you have. 

I often teach the following relaxation exercise: Close your eyes.

Take a big deep breath inhaling deeply into your abdomen. As you inhale, imagine a golden white light filling your body. As you exhale slowly, feel all of the stress and tension leaving your body and being replaced with peace and calm. Repeat this process three times.  You will be amazed at how much more serene you will feel.  Even the busiest executive on Wall Street can allow herself forty or fifty seconds to de-stress each hour.

CELEBRATION Create a ritual of celebration that you can perform either alone or with friends and loved ones to welcome the changes that are occurring in your body and in your life. Look to the positive aspects of this new phase of  life.

It is up to us to take back our power as we confront the changes in our physical bodies, to nurture ourselves in body, mind and spirit as we enter the age of wisdom.