The Blessings of Menopause

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When the end of the childbearing years arrive at last for American women, why do they not celebrate?

Just think of it. No more menstrual cramps or "accidents." No more nervous counting, endlessly reviewing the last 28 days, on day 32, wondering if you have just lost control of your life.

In fact, in many cultures around the world, celebration is precisely the response. Menopause is a rite of passage, a milestone at which women are honored. This is the point where women lead in the revered society of the wise. Menopause is viewed culturally as a divine blessing and, interestingly, women in those societies pass through menopause without symptoms! They do not experience hot flashes, night sweats, vaginal atrophy, or even evidence of osteoporosis![ 1]

A good portion of suffering that women experience has its roots in the way our American culture views older women.

Emphasis on Youth
Our society worships youth. In every advertisement, every television show, even the commentators on the evening news, the people you see are young and attractive. Beautiful people are even cast for the roles of older characters or ugly ducklings. Nip-tuck-changelings are the rage in our culture.

Estrogen "Deficiency"?
It was in 1966, in fact, when Dr. Robert A. Wilson published his pivotal medical text and stated that menopause was actually an estrogen-deficiency disease that must be treated medically like any other disease.[ 2] In Forever Feminine, he posited that women who did not replenish their declining estrogen levels would become sexless "caricatures of their former selves . . . the equivalent of a eunuch."

Honored medical doctors and pharmaceutical companies offer women relief with synthetic hormone replacements, herbalists brew strange-smelling tea, ancient Chinese men in dimly lit shops offer roots to chew. Then, of course, there is soy. With between 40 and 60 million women in the U.S. who are statistically likely to be menopausal, all of this is big business.

Symptoms
Common symptoms of menopause can include temperature fluctuations (hot flashes), perspiring at night, headaches, atrophic vaginitis, frequent urinary tract infections, cold hands and feet, forgetfulness, an inability to concentrate, aggressiveness, anger, and depression.[ 3]

What could possibly be the root of such havoc in the female body? Oddly enough, it all starts some 50 years earlier. At birth, each woman has about one million ova (eggs) in the ovaries. Each egg is housed in a follicle or cellular sheath. By the time a woman reaches menopause, few eggs remain, thus resulting in fewer active follicles. The absence of active follicles results in reduced production of the sex hormones estrogen and progesterone. With fewer hormones circulating, compared with the fertile years, the pituitary gland kicks into "backup" mode, increasing secretion of two pinch-hitters: follicle stimulating hormone (FSH) and luteinizing hormone (LH). LH and FSH cause the ovaries and the adrenal glands to secrete increased amounts of androgens. Androgens are converted to estrogens by fat and muscle cells, particularly by the fat cells of belly and by those of the hips and thighs. After menopause, FSH and LH continue to be secreted in large quantities even though there are no longer any follicles.

Is there some pill that women can take for these symptoms?

"Why, yes," your doctor might say. Estrogen replacement therapy (ERT) started back in the days of our friend Dr. Wilson, when he made us believe that "all postmenopausal women are castrates." This view fell out of favor, however, when serious and clear links to various forms of cancer and other deadly diseases began to surface. ERT was replaced by modern medicine with hormone replacement therapy (HRT), which is basically the same old ERT with progesterone. Found to be less conducive to disastrous disease, HRT is available in any number of forms, from tablets to patches.[ 4]

Pitfalls of Hormone Therapy
But is HRT safe? On July 20, 2002, officials abruptly halted a major randomized clinical trial within the Women's Health Initiative (WHI) that involved more than 16,000 women ages 50 to 79.

Early results indicated that HRT under trial, a combination of progestin (a synthetic form of progesterone) and conjugated equine estrogen (marketed as Prempro™), slightly increased their risk of breast cancer, heart disease, blood clots, and stroke. Specifically, the product was associated with:

20 percent increase in heart attacks.
41 percent higher rate of stroke.
more than a 100 percent increase in blood clots in the lung.
Further study results had to do with symptoms of depression, memory loss and confusion, hot flashes and night sweats, sleep quality, and sexual functioning. The study subjects were divided into two groups. Half of the women received Prempro, and half were given a placebo. When the women were retested one year later, the researchers found no appreciable difference between the Prempro group and the placebo group,[ 5] concluding that the risk outweighed the benefit.

In fact, the Food and Drug Administration has since advised health care professionals to prescribe estrogen products in their lowest dose form and for the shortest possible duration. Women who take such products are cautioned to undergo yearly breast assessments in a medical setting, to perform monthly breast self-examinations, and to receive periodic mammography.[ 6]

HRT is still widely prescribed, but now it is known as HT (hormone therapy), in recognition that replacement of a woman's hormones may not be advisable or, indeed, even possible.

Natural Alternatives to Hormones
So are there other options? There are a growing number of natural alternatives, some with some impressive studies to back them. Most of these studies are being conducted outside the range of the FDA and the American drug industry.

An information service offered by the U.S. National Library of Medicine and the National Institutes of Health lists most of the popular alternatives. Any molecule that is natural cannot be patented and thus cannot be marketed as the specific property of any one drug company.

As such, natural molecules are not tested with as much vigor or accepted with as open arms as are laboratory-created molecules. However, given the topic of laboratory-created alternatives, perhaps some consumer education about natural alternatives is warranted. (Editor's Note: These items may interact with certain medications and other substances. Readers should consult with their physicians before beginning treatment.)

Soy Products. Soy contains high amounts of isoflavone, which is phytoestrogen (plant estrogen). It acts like human estrogen to a weaker degree. Readers should be sure to use only nongenetically modified soy and should look for the words "non-GMO" on the label.[ 8] (Editor's Note: For more information on soy, see page 3.)

Black Cohosh. Black cohosh is a North American plant, commonly used to treat hot flashes and sleep disorders as well as depression. There is an impressive study on the effectiveness of this plant from Germany.[ 9]

St. John's Wort. An extract of the flower Hypericum perforatum, St. John's wort has been used for hundreds of years to treat mild-to-moderate depression. However, it may cause problems when used with laboratory-created antidepressants and other drugs.[ 10]

Wild Yam. Wild yam (and Mexican yam), which is available in extracts, tablets, and creams, has been growing in popularity among women for relief of menopausal symptoms. Be sure to get a cream from a reputable source. Not all wild yam is created equal, and not all wild yam can be converted into human hormones by the body.[ 11]

Dong Quai. The root of the plant Angelica sinesis, dong quai is the most commonly prescribed Chinese herbal medicine for problems that affect the female reproductive system. It is often included among the ingredients in herbal remedies.[ 12]

Evening Primrose. Evening primrose is a North American wild-flower. Oil is expressed from the plant's seeds. Some women use this oil to treat hot flashes. By word of mouth, you may hear good reports, but official drug and government sources say that there is no proof that it works.[ 13]

Valerian Root. Valerian root comes from the garden plant heliotrope. It is usually used to treat sleep problems. More than 50 percent of the women in the WHI study on menopause reported sleep disturbance as a symptom.[ 14]

Ginseng. There are many types of ginseng: Siberian, Korean, American, white, and red. Ginseng is said to increase a woman's desire and energy levels during menopause.[ 15]

Chasteberry. Agnes vitex is the dried ripe fruit of the chaste tree. It is said to reduce the desire in men to have sex but to increase it in women. Some think that it helps to reduce vaginal dryness and depression at menopause. Again, it is often included among the list of ingredients in an herbal alternative.[ 16]

Estrogen Levels Throughout Life
There is another point in a woman's life when her estrogen levels are similar to what they will be after menopause, and that is before the onset of menses. Up until sometime around age 13, women usually go happily through life without suffering any major complaint from lack of estrogen. In fact, it is the onset of estrogen production in large quantities that most women will point to as the start of all the trouble in the first place. Nonetheless, at some point in a woman's early life, the hypothalamus gland in the brain starts secreting gonadotropin-releasing hormone (GnRH). Eventually, GnRH triggers the release of other hormones that trigger the production of estrogen and progesterone by the ovaries; suddenly a woman is fertile.

Before that point, however, sex hormone levels are similar to those after menopause. In fact, it is not the lack of estrogen that drives our bodies into frenzy but the wild fluctuation of those hormonal levels.

With all the fuss over how to treat menopause, have we lost sight of the fact that it is just a "between" state? Someday it will end, and our bodies will adjust, settling into a nice, comfortable routine.

CARTOON

CARTOON

References
1. Martin, M.C. Block, J.E., Sanchez, S.D., et al. Menopause without symptoms: The endocrinology of menopause among rural Mayan Indians. American Journal of Obsetrics and Gynecology 1993; 168:1839-1845.

2. Wilson, R.A. Forever Feminine. New York: Evans; 1966.

3. Menopause Naturally. Impakt Communications, 2000.

4. Managing Menopause.

5. Women's Health Initiative Study.

6. U.S. Food and Drug Administration, Rockville, Md.

7. National Institutes of Health, Bethesda, Md.

8. Adleson, H.D. The Naturopathic Approach to the Treatment of Menopause. Salt Lake City, Utah. Menopause Online.

9. The Cimicifuga preparation BNO 1055 vs. conjugated estrogens in a double-blind placebo-controlled study. Maturitas 2003; 44 (Suppl. 1): S67-S77.

10. Davies, J.R. The incredible journey of herbal medicine. Positive Health.

11. Knight. Encyclopedia of Healthy Herbs.

12. Op cit., Adleson, H.D.

13. Gittleman, A.L. The Fat Flush. New York: McGraw-Hill, 2001.

14. Grieve, M. Leyel, C.F. Modern Herbal. Dover Publications; 1971.

15. Vuksan V., Sievenpiper J.L., Fancis, T., et al. American ginseng. (Panax quinquefolius L.) reduces postprandial glycemia in nondiabetic subjects and subjects with type 2 diabetes mellitus. Archives of Internal Medicine 2000; 160:1009-1013.

16. Schnellenberg, R. Treatment for the premenstrual syndrome with Angus castus fruit extract. British Medical Journal 2001; 322:134-137.

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By Gail German

Early Diagnosis Is Key for Menopause
It is never too early to talk about menopause.

That is the opinion of Karen Bradshaw, M.D., Professor of Obstetrics and Gynecology at the University of Texas-Southwestern Medical Center at Dallas.

"In my practice, I've often seen women with menopausal symptoms who are in their 30's — and that's just the ones who are coming for diagnosis and treatment," says Dr. Bradshaw, a reproductive endocrinologist. "There are a lot out there who aren't being helped because even though they are having symptoms like hot flashes, vaginal changes and depression, they don't know what's wrong."

She says that early diagnosis is important so that treatment can begin immediately. Not only are the symptoms unpleasant, but physical disorders may also be associated with declining estrogen levels as women experience menopause. Some of these problems include bone loss (osteoporosis); atherosclerosis, which can lead to heart problems or stroke; bladder incontinence; and cancers of the breast and reproductive system.

Any woman in childbearing years, no matter her age, who starts having heavy menstrual bleeding, "hot flashes," sudden mood swings, or other symptoms associated with menopause should visit her primary care physician or gynecologist, Dr. Bradshaw says.

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