“Weakness in woman.” This is how 17 “leading medical specialists” categorized menopause in a 1943 health book. Attitudes and health care for menopause have improved over the decades, but are women getting the best care possible? Let’s look at what natural health care providers can offer for menopause, as well as how society’s perspective on it can help or hinder a menopausal woman.
What is menopause?
Women usually experience menopause, the cessation of the menstrual period, when they’re about 50 years old. However, the decrease in hormones, called climacteric, is a long process that begins when a woman is in her 40’s and ends during her 70’s. Changes occur in four main hormones that orchestrate the menstrual cycle: estrogen, progesterone, follicle stimulating hormone (FSH) and luteinizing hormone (LH).
After a woman has menstruated for 30 years, fewer of her follicles (the layer of cells that surround each egg in the ovary) mature each month, and the ones that do are less sensitive to hormones. As a result, cycles shorten or become irregular. Estrogen levels decrease and FSH levels increase. After 10 years of slowing down, there comes a day when estrogen is so low that menstruation stops and menopause begins. Medically, a woman is considered menopausal when she has no period for six to 12 months after age 45.
Although we recognize now that menopause is a natural part of life, not a disease or Weakness, it’s difficult to erase years of myths and stereotypes. Menopause was basically ignored by doctors until the mid-nineteenth century. When it was finally acknowledged, many physicians spent the next 60 years perpetuating the image of the irascible menopausal woman. Even today, women are seen as overanxious about their health leading some doctors to judge “women’s complaints” as emotionally based (1).
Opinions about menopause vary between cultures. In Japan, for example, menopause is seen as a natural transition into the latter part of life. One survey reported under 10 percent of
Japanese women have hot flushes, whereas some American physicians claim that 85 percent of their menopausal patients experience these symptoms (2).
What causes menopausal symptoms? Psychologists may point to early, unresolved conflicts that resurface during climacteric as the cause. Sociologists emphasize life changes, such as the death of parents. Physicians list deficient estrogen levels as the reason (2).
Most of us are familiar with the most common menopausal symptom: the hot flush or flash. Reddening of the head, neck and chest accompanied by heat and perspiration can last for seconds or half an hour. Flushes can plague a women for one, five or even 10 years.
They are most severe at night, during stress or following alcohol consumption.
Atrophic vaginitis, a dry, itching vagina, can also result from estrogen decline. This and a change or decrease in libido can temporarily alter a woman’s sexual activity. However, when older married women are compared to older married men, the percentage who has sex is almost identical.
A group of more subjective complaints has been labeled “menopausal syndrome”. These include fatigue, nervousness, headaches, insomnia, depression, irritability, dizziness, palpitations, and joint and muscle pains. Some of these vague symptoms are blamed on hot flushes. For instance, wouldn’t waking up in the middle of the night drenched in sweat give you insomnia, make you feel tired and subsequently irritable, nervous and perhaps give you headaches?
As for menopausal depression, the research done on this symptom may be flawed and results vary from study to study. For example, age, not menopause, is frequently used as a marker in these investigations. A National Institute of Mental Health report showed that women 45 and older actually suffered less occasions of depression than younger females (3,4).
According to one survey, approximately one-quarter of postmenopausal women rely on synthetic estrogen to carry them through menopause and beyond. Another six percent use both progesterone and estrogen (5). For many who use estrogen replacement therapy (ERT), hot flushes are cooled, vaginal atrophy diminishes and osteoporosis and cardiac disease are said to decrease.
In exchange for these benefits, a woman may suffer from irregular vaginal bleeding (6) or increase her risk of breast and endometrial cancer, especially if she has a personal or strong family history of cancer (7). Estrogen given alone can cause adverse effects. Many gynecologists now supplement menopausal patients with a new version of ERT called hormonal replacement therapy (HRT), a combination of estrogen and progesterone.
However, even HRT isn’t without risk. Some British researchers suggest that HRT is addictive, claiming PMS, postpartum depression and menopausal depression are evidence that female hormones alter mood. HRT can promote feelings of well-being and some women on HRT show signs of drug dependency. In light of this, blanket HRT prescriptions for all menopausal women over long periods of time could be dangerous (8). Some naturopathic physicians only recommend HRT for patients at high risk of developing osteoporosis.
The damaging effects of the three type of active estrogens used during hormonal therapy is a health issue seldom addressed in the U.S. Estrone (E1), formed from estradiol and a substance called androstenedione, which originates mainly from the adrenals, can induce cancer. Estradiol (E2), the primary estrogen secreted by the ovaries, may also lead to cancer though the chances are smaller. The weakest form of estrogen, estriol (E3), is mainly converted from estrone in the liver. A small fraction of estradiol can also be changed into estriol.
For years, European clinicians have used estriol in recognition of its noncancerous and possibly cancer protective properties. A New England Journal of Medicine study revealed elevated estriol levels in animals guard them against the tumor-inducing effects of estradiol and estrone–the estrogen forms used to treat menopausal women in the U.S. (7).
Menopause doesn’t mean that a woman’s estrogen supply dries up overnight. Her adrenal glands and fatty tissue continue to contribute to an estrogen reservoir that gradually diminishes over several years. If a woman chooses to forgo HRT, she can boost her natural
hormone pool somewhat using herbs, supplements and lifestyle habits.
Phytoestrogens are plant sources of estrogen. Botanicals such as Dong quai, licorce, black cohosh, unicorn root and false unicorn root exert about 1400 of the estrogenic activity seen in synthetic forms. Phytoestrogens work by balancing your natural hormone levels either up or down, whatever is needed.
There are no long-term, well controlled studies on the effects of phytoestrogens and other natural hormone sources. Most of the evidence we have at this point is based on clinical observations. Therefore, naturopathic physicians and other natural health practitioners disagree about when and how long phytoestrogens should be used.
These botanicals do not appear to cause side effects. However, many physicians follow certain guidelines when prescribing them. If a women is pregnant, has abnormal vaginal bleeding, thrombophlebitis or a history of this, phytoestrogens should be avoided. If she has a history of a related disorder connected with estrogen use, cancer related to estrogen use, or known or suspected breast cancer, any type of estrogen–including a natural source–should not be used (5).
At the USDA’s research facility in Grand Forks, North Dakota, Forrest Nielsen, PhD has done some ground breaking studies on the effects of a relatively obscure mineral, boron. In postmenopausal women fed three mg of boron each day, estrogen rose equivalent to
“levels found in women on estrogen replacement therapy” (9). Boron supplementation also decreased calcium lost through their urine by 40 percent (10). Dark green, leafy vegetables, fruits (not citrus), nuts and legumes all contain boron. If you decide to take boron supplements, consult with a physician. Too much boron could cause increase your risk of osteoporosis (11).
There’s also evidence that lifestyle can influence a woman’s natural estrogen levels. One study discovered smoking altered the breakdown of estrogen in the liver and subsequently lowered one form of estrogen in the blood (12). Another investigation revealed a relationship between increased caffeine intake and decreased free estrogen (13).
Bolstering hormone levels will often allay hot flushes. In addition to doing this, regular exercise, balanced eating and minimizing stress will soften the symptoms of menopause. This is particularly true for the irritability, fatigue and depression of menopausal syndrome.
Hot flushes can be cooled very simply. If a woman dresses in layers using natural fibers that breath, she will not get as hot and she can remove clothing as the flush heats her up. Avoiding or minimizing caffeine and alcohol can decrease the severity of hot flushes. Drinking plenty of water and using vitamin E may help too.
Finnish researchers noted that Japanese who ate a traditional diet low in fat and high in soy foods such as tofu and miso excreted as much as 1000 more phytoestrogens in their urine as American women. This means that Japanese women consume considerable more phytoestrogens in their diet–one reason why hot flushes and other menopausal symptoms may be less frequent in that country (14).
Hormones and Your Heart
One argument for prescribing HRT is the protection it offers against heart disease, a condition that rises in women as their estrogen levels decrease. However, Jan Vandenbroucke, MD, a Dutch professor, says that the evidence supporting this claim isn’t
Vandenbroucke states that for the past 20 years scientists have been questioning whether estrogen benefits the heart. Three situations have fueled this debate. In studies where estrogen was given to men to see if it prevented recurrence of heart problems, the results weren’t good. Also, birth control pills, which contain estrogen and progesterone, tend to promote vascular disease in young women. Last, the argument that HRT or estrogen protects postmenopausal women from heart disease has its flaws. Vandenbroucke reviewed a large study investigating the effect of estrogen on death from heart disease. He found that when women who had heart problems before the investigation began were excluded from the final results, estrogen therapy didn’t decrease the risk of developing heart disease. He speculates that progestagens, synthetic progesterone used in HRT, cancels out estrogen’s benefits, if any.
Estrogen does appear to lowering blood fats, which play a role in heart disease. If this is so, says Vandenbroucke, “a more direct attack on lipids would seem logical.” Many naturopathic physicians agree. Rather than relying on hormonal therapy to decrease blood lipids, it would be far safer to use diet, botanicals and nutritional supplements to achieve this goal (15).
One-third to one-half of postmenopausal women suffer from osteoporosis (16). Age and sex, genetic predisposition, race and weight determine if you are at risk of developing this
disease. A woman should think of strong bones as money in the bank. To help your bones, you should exercise, eat a balanced diet and not smoke. You should practice these good habits throughout your life in order to deposit a maximum amount of bone before withdrawal begins at age 35.
Calcium supplementation has been offered as the main solution to preventing osteoporosis. Once menopause begins, HRT is often used. Both treatments have their limits and problems. Calcium does not carry the same risks as synthetic hormones, but this mineral is not the final answer to a chronic, progressive disease.
Pre-adolescent children (17) and postmenopausal women (18) appear to gain the most from calcium supplementation. The calcium source also makes a difference. Dairy products are reported to be the most calcium-rich food. Lactose, or milk sugar, is said to make calcium more accessible to the body (19). Milk calcium is also less likely to inhibit manganese, a mineral necessary for bone formation, than supplemental calcium (20). On the other hand, some experts argue that the phosphorus and protein content of milk decreases the availability of dairy’s calcium. If you are allergic or sensitive to milk, or are lactose intolerant, dairy foods can not be eaten.
The Bantu women of South Africa consume only 220 to 440 mg of calcium each day, yet osteoporosis is rare (21). It’s not enough to eat a lot of calcium to ensure strong bones. You also need to control those substances and habits that rob the body of calcium such as caffeine, alcohol, smoking, sugar, sodium, phosphates and excessive animal protein (22,23,24,25).
We tend to forget that bone is a living tissue that, like other body systems, requires many nutrients besides calcium. In fact, when these extra nutrients are used together with calcium, bone loss is less dramatic (26). Vitamins B6, D and K, folic acid, magnesium, manganese, strontium, silicon, boron, zinc and copper are all instrumental in maintaining the skeleton (27).
- Council on Ethical and Judicial Affairs, American Medical Association. Gender disparities in clinical decision making. Journal of the American Medical Association 1991; 266: 559-62.
- Lock M. Contested meanings of the menopause. The Lancet 1991; 337: 1270-72.
- Youngs DD. Some misconceptions concerning the menopause. Menopause, Sexuality, Depression 1990; 75: 881-3.
- Gath D, Iles S. Depression and the menopause. British Medical Journal 1990; 300: 1287-8.
- Harris RB, Laws A, Reddy VM, King A, Haskell WL. Are women using postmenopausal estrogens? A community survey. AJPH 1990; 80(10): 1266-1268.
- Whitehead MI, Fraser D, Schenkel L, Crook D, Stevenson JC. Transdermal administration of oestrogenprogestagen hormone replacement therapy. The Lancet 1990; 335: 310-312.
- Follingstad AH. Estriol, the forgotten estrogen? Journal of the American Medical Association 1978; 239(1): 29-30.
- Bewley S, Bewley TH. Drug dependence with oestrogen replacement therapy. The Lancet 1992; 339: 290-1.
- Nielsen FH. Nutritional requirements for boron, silicon, vanadium, nickel, and arsenic: current knowledge and speculation. FASEB 1991; 5: 2661-2667.
- Nielsen FH, Hunt CD, Mullen LM, Hunt JR. Effect of dietary boron on mineral, estrogen, and testosterone metabolism in postmenopausal women. FASEB 1987; 1: 394-397.
- Nielsen FH. Facts and fallacies about boron. Nutrition Today, May/June 1992: 6-12.
- Cassidenti DL et al. Short-term effects of smoking on the pharmacokinetic profiles of micronized estradiol in postmenopausal women. Am J Obstet Gynecol 1990; 163(6). Pt 1: 1953-1960.
- London S, Willett W, Longcope C, McKinlay S. Alcohol and other dietary factors in reation to serum hormone concentrations in women at climacteric. Am J Clin Nutr 1991; 53: 166-171.
- Adlercreutz H et al. Dietary phyto-estrogens and the menopause in Japan. The Lancet 1992; 339: 1233.
- Vandenbroucke JP. Postmenopausal oestrogen and cardioprotection. The Lancet 1991; 337: 833-4.
- Licata, A. A., Therapies for Symptomatic Primary Osteoporosis. Geriatrics 1991;46: 62-67.
- Johnston, Jr, C.C., Miller, J.Z., et al. Calcium Supplementation and Increases in Bone Mineral Density in Children. NEJM 1992;327: 82-87.
- Andon, M.B., Smith, K.T., Bracker, M., Sartoris, D., Saltman, P., and Strause, L. Spinal Bone Density and Calcium Intake in Healthy Postmenopausal Women. Am J Clin Nutr 1991;54 : 927-9.
- Shahkhalili, Y., and Mettraux, C., “Relative Importance of Carbohydrate and Protein Sources in the Differential Effects of Soy-based vs Casein-based Formulas on Bone Minerals in Rats,” Am J Clin Nutr 53 (1991): 947-53.
- Raloff, J., “Reasons for Boning up on Manganese,” Science News 130 (1986): 199.
- Mickelsen, O., and Marsh, A.G., “Calcium Requirement and Diet,” Nutrition Today (Jan/Feb 1989): 28-32.
- Hernandez-Avila, M., Colditz, G.A., Stampfer, M.J., Rosner, B., Speizer, F.E., and Willett, W.C. Caffeine, Moderate Alcohol Intake, and Risk of Fractures of the Hip and Forearm in Middle-aged Women. Am J Clin Nutr 54 (1991): 157-63.
- Mazess, R.B., and Barden, H.S. Bone Density in Premenopausal Women: Effects of Age, Dietary Intake, Physical Activity, Smoking, and Birth-Control Pills. Am J Clin Nutr 1991; 53: 132-42.
- Wisneski, L.A. Clinical Management of Postmenopausal Osteoporosis. S Med J1992; 85: 832-39.
- Werbach, M.R., Nutritional Influences on Illness Tarzana: Third Line Press, 1988.
- Anon. Lactose intolerance. The Lancet 1991;338 : 663-4.
- Gaby, A.R., and Wright, J.V., Nutrients and Bone Health, Wright/Gaby Nutrition Institute (1988): PO Box 21535, Baltimore, MD 21208.