What is menopause? Menopause is the cessation of a woman’s monthly blood flow. If a woman has not experienced menstrual flow for 12 consecutive months, she is menopausal.

Except in the case of surgery, chemotherapy or specific medical conditions that interfere with regular hormonal functions, menopause occurs at the end of a process, which may last from months to years. During the process, periods may become irregular but not stop and a woman may intermittently experience other symptoms of menopause. When a woman is experiencing symptoms but has not yet been without periods for 12 consecutive months, she is peri-menopausal. A woman may become peri-menopausal as early as her thirties or as late as

her fifties.

What are symptoms of menopause? Symptoms of menopause fall into five broad categories:

1) Changes in blood vessel dilation and constriction. This blood vessel activity causes hot “flashes” and sleep irregularities. Hot flashes are not related to the internal temperature of the body but rather to the temperature of the skin. There are various theories about why, during menopause, women’s skin temperatures may rise periodically as much as 7 degrees. One of the most intriguing theories is that women who experience hot flashes have a very narrow comfort zone - that zone where they are neither sweating nor chilled. Estrogen seems to widen that zone; conversely lower estrogen narrows the zone.

(Studies conducted by Dr. Robert R. Freedman and colleagues, Wayne State Univ., Detroit). Hot flashes contribute to sleep irregularities.

2) Urinary/genital tract changes. Women may experience thinning, drying, itching and bleeding in the vaginal area sometimes associated with pain on intercourse. Another issue may be urinary frequency, urgency or incontinence.

3) Bone changes. Changes in the bones may result in osteopenia (pre-osteoporosis), osteoporosis, joint and muscle pain or back pain.

4) Skin and soft tissue changes. Skin may thin as part of menopause or lose elasticity and breasts may become smaller. These changes are associated with the loss in estrogen that accompanies menopause.

5) Psychological/mood changes. Changes in mood may include irritability

and depression or be accompanied by fatigue and memory loss.

How can menopausal discomforts be moderated? Not all women experience menopausal discomfort at a level that it requires therapy. How women experience menopause, a natural stage in the lifecycle of a woman, is in part a matter of genetics, in part a matter of general health and nutrition and in part a matter of culture. There has been great interest lately in the fact that Asian women typically do not engage in hormone replacement therapy or consume dairy products and yet have virtually no osteoporosis as they age and progress through menopause.

1) Self-care. Ideally a self-care program begins well in advance of menopause. Preferably

it is a lifelong project. It is never too late to begin, however. Self-care includes good nutrition, effective and regular exercise and mood maintenance.

Good nutrition means the appropriate balance of carbohydrate, protein and fats. Carbohydrates and fats should be of the types that promote health, that is, complex carbohydrates low on the glycemic index and mono-unsaturated and poly-unsaturated fats with the correct balance of omega 3s and omega 6s. For vitamins and minerals, eat a wide range of vegetables, fruits, nuts, grains and beans daily. Maintain the proper Ph balance in the body by limiting dairy products except for probiotics like yogurt. Eliminate simple sugars from the diet as much as possible and

focus on getting adequate fiber in the diet.

Establish a daily exercise routine that includes weight bearing exercise, stretching and low-impact aerobic activity. Maintain a healthy weight. Maintain mood with proven techniques like focused breathing, meditation, a gratitude journal, meaningful activity and significant, satisfying relationships.

2) Nutritional approaches. There is a wide range of nutritional alternatives to HRT, often combined with a program of supplementation and /or herbal therapies as well as with the self-care techniques mentioned above. While some sources indicate these alternatives are not clinically proven, they have nonetheless been effective for many women.

Nutritional approaches may include plant estrogens, such as those found in soy products as well

as oats, cashews, almonds, alfalfa, apples and flaxseeds. Magnesium can also help to reduce hot flashes. Magnesium is found in soy products and in whole grains and beans. Sufficient dietary fiber can help to reduce irritability. Essential fatty acids can alleviate symptoms of aging, including a reduction in skin elasticity and they can help with dryness in the vaginal region. They also act as natural hormone supplements. Multivitamin/mineral supplements should be chosen with particular attention to their magnesium content. In addition, vitamin E can have a significant impact on vaginal dryness and hot flashes. A variety of herbs have been used, among them, wild yam (for hot flashes), alfalfa, sarsaparilla, motherwort (vaginal dryness), valerian root (promotes sleep), ginseng and black cohosh. Dong quai has been used for centuries in China to provide relief for menopausal symptoms.

3) Hormone Replacement Therapy (HRT). HRT has been the most common therapy for the symptoms of menopause in the United States. It is particularly effective for hot flashes, virtually eliminating them shortly after therapy is begun. It has long been considered effective in protecting against osteoporosis because of the effect of estrogen in strengthening bone and enhancing calcification.

Following the Women’s Health Initiative Study (WHI) of the National Institutes of Health, halted in July 2002, HRT has become controversial, however. Although hormone replacement has been proved to

offer many benefits, including reduced osteoporosis, there are also greater risks associated with it, including breast cancer. Patients and physicians must make the decision about HRT together, based on individual medical situations. Not only is there a decision about whether or not to use HRT but what kind of HRT: unopposed estrogen (estrogen alone), estrogen and progestin, or one or both of those hormones administered along with testosterone. Among the other things a physician will consider with his/her patient is genetic history and age. There are also differences between women with an intact uterus and women without a uterus. While breast cancer is a greater risk for the first, osteoporosis may be a greater risk for the latter. Recent reports suggest that extended use of unopposed estrogen in women who have had a hysterectomy may even reduce breast cancer, although it poses unacceptably high cancer risks to women who have not had a hysterectomy. In the latter case if used, estrogen will probably be accompanied by progestin. There has been recent interest in bioidentical hormone replacement therapies, that is, estrogen and progestin that duplicate the hormones in a woman’s body (as opposed to equine hormonal products). Studies are promising but not yet advanced enough for certainty.

Special issues. Among particular issues that may confront women in

relation to the significant physical change that menopause represents are fibroids and osteoporosis. Fibroids are primarily associated with peri-menopause, that is, the time before menopause, which is marked by twelve consecutive months in which there is no menstruation. While osteopenia may begin during the peri-menopausal time, osteoporosis is associated more strongly with menopause and aging.

1) Fibroids. Fibroids are (usually benign) tumors, generally located in the uterus or uterine wall. They may range in size from less than an inch to larger than a grapefruit. Size is often explained by relating it to pregnancy, i.e., eight weeks or twelve weeks. No one is certain exactly what causes fibroids, although generally they shrink after menopause,

so estrogen levels may be a factor.

Women are most likely to have fibroids if they are of childbearing age, are African-American, are obese and / or have not had children. Fibroids have been linked to an under active thyroid, so thyroid testing, treatment and monitoring should certainly be part of a preventive reproductive health program. Most women do not experience symptoms. If there are symptoms, they are most likely to include heavy bleeding or painful periods, bleeding between periods, frequent urination, pain during sex, lower back pain, reproductive problems, or a feeling of fullness or swelling in the lower abdomen. Treatments include drugs (pain relievers or

medications to reduce the size of the fibroids), surgery (myomectomy, hysterectomy, endometrial ablation, myolisis); and uterine fibroid embolization (UFE). Myomectomy removes the fibroid but leaves the healthy uterine tissue. Hysterectomy removes the entire uterus. Endometrial ablation removes the endometrial lining of the uterus, which relieves heavy bleeding. In myolisis, an electrical needle is inserted into the uterus through a small incision in the abdomen to destroy the blood vessels feeding the fibroid. UFE is a treatment that cuts off the blood supply to the uterus and the fibroids so they shrink. It is becoming an alternative to hysterectomy and myomectomy. Which of these treatments is used must be determined in consultation with a physician. The clinical evidence supporting natural treatments for fibroids is scarce. For the most part, natural treatments are preventive or treat the symptoms but do not address the fibroids themselves once they are in place.

There are some reports that eating less red meat and pork reduces fibroids and some women have reported success with becoming vegetarian. Include raw nuts, seeds, fruits and vegetables in the diet as well as foods high in germanium, that is, garlic, shiitake mushrooms and onions that help improve tissue oxygenation. Avoid caffeine, which has been implicated in fibrocystitis. Recommended nutritional supplements include vitamins A, B-complex, C, K and bioflavonoids. Recommended botanical herbs

include chaste tree, ginger, cranesbill, shepherd’s purse, ragwort, blue cohosh and false unicorn as well as ginseng, rhubarb, cinnamon and sargassum seaweed in various combinations. These treatments and appropriate combinations must be discussed with a naturopath.

2) Osteopenia, Osteoporosis. Bone constantly reforms throughout our lives. Cells called osteoclasts reabsorb bone material while cells called osteoblasts generate new bone material. As people age, the process of reabsorbing bone material outstrips the process of generating new bone material.

Osteopenia and the more advanced osteoporosis represent an imbalance in reabsorbtion / bone generation in which osteoclasts are more active than osteoblasts, a situation caused by a reduction in estrogen. Estrogen has an important role in the strengthening and

calcification of bone. A drop in estrogen at the time of menopause may also be associated with a decreased ability of the body to absorb calcium efficiently. One of the problems in how the news of the Women’s Health Initiative was brought to the public was that the increased risk of breast cancer demonstrated in some segments of the study were highlighted and other aspects of the health risks associated with aging and with menopause obscured. There is a feeling among some specialists that as a result, women are being advised to abandon HRT, at great risk to their future health. There are reports indicating that the greater danger is osteoporotic fracture and consequent disability and confinement to nursing homes at a much younger age than might otherwise be required.

Michael Russell

Your Independent guide to [http://menopause-guided.com/]Menopause