Womenopause

While I was trying to decide whether to write this article on
menopause or miscarriage, I found myself surrounded by women asking me about
their hot flashes, even at a potluck brunch last week. When I mentioned the
upcoming article, one of the women exclaimed, “Be sure to say that it should
never have been called ‘menopause’! After all, it’s we women who experience
it, not men.” I told her I never thought of it that way, but that I could see
her point.I began to feel that this article on meno- pause somehow wanted to
be written. Then, yesterday, I received a call from a free-lance writer on the
East coast who asked me if I could give her information on the homeopathic
treatment of menopause because she felt it was a topic so many women were
thirsting to know about. So, here’s the article the universe seems to be
asking me to write. Please forgive me if it seems hypocritical to keep using
the word “menopause” despite what I’ve already mentioned but, whether we like
it or not, it’s the term we’re most familiar with. The term menopause refers
specifically to the final stopping of the menstrual flow in a woman’s life;
perimenopausal to the time around this last period; and post-menopausal to
after the last period. Climacteric is another term which may encompass the
entire time period.

Menopausal Myths: Let me begin by sharing some of our common myths
about the menopausal experience. l) Menopause is inevitable. There’s not
much I can do to delay it. You’re right that you can’t avoid menopause
(that’s not to say every woman even wants to!) but certain lifestyle factors
such as smoking, drinking too much alcohol or coffee, or significant emotional
stress can bring on menopause earlier. 2) Doesn’t every body have to go
through hot flashes? Most women, about four out of five, do experience hot
flashes, to a greater or lesser degree, but the frequency, intensity, and
duration varies tremendously. For some women it’s terribly uncomfortable and
embarrassing; for others only a minor irritation.3) I had my ovaries removed
in my twenties because of cancer and have been on hormones ever since, so I
don’t have to go through hot flashes. Women who have had their ovaries
removed and taken supplementary estrogen for a number of years can still get
hot flashes once they stop taking the hormones. 4)The only way to get rid of
hot flashes and vaginal dryness is to take estrogen. Homeopathy, herbs,
diet, nutritional supplements, and other natural thrapies can be very effective
in treating these symptoms, and a growing number of women are thinking twice
about automatically taking hormones once they reach menopause. 5) All I have
to do to prevent osteoporosis is to take plenty of calcium. Taking calcium
supplementation, however large the amount, is not sufficient to prevent
osteoporosis, as you’ll understand more later in this article. 6) So much
for my sex drive! Menopause does not necessarily mean a plunge in sexual
energy. Many women find sex quite pleasureable, and more liberated, after the
menopausal years.

These are only a few of the many misconceptions about menopause and new
information is surfacing all the time to separate menopausal facts from
fallacies. Three books which I found helpful in sorting out current information
are Menopause Naturally by Sadja Greenwood (which provides lots of good
medical information and support but actually not much in the way of natural
therapies), The Calcium Plus Workbook by Evelyn Whitlock and
McDougall’s Medi-cine: A Challenging Second Opinion by John McDougall.
I’d like to share with you what I feel is most important about menopause,
answer questions I hear many women ask about the experi-ence, and give you some
ideas about natural treatment which you can consider for yourself.

When can I expect to stop having periods and what will it be like?
Most women stop having periods somewhere between 48 and 52, but this may
occur earlier or later, depend-ing on lifestyle, heredity, and other factors.
Hot flashes, vaginal dryness, and night sweats are the most common symptoms,
however many women also experience delayed or more frequent periods, heavy or
scant menstrual bleeding, and mood changes such as irritability or depres-sion.
These symptoms may occur fleetingly, or may last for several years or more.
I’ve seen a number of women who have made the transition through menopause
quite easily, with a mini- mum of symptoms. Other women, usually those who went
through menopause without knowing help was available for them, may have a
different story to tell and be very glad that it’s all over. Many women think
they’re starting menopause in their early forties, then discover that their
abnormal bleeding is caused by uterine fibroids (see the August, l990 issue of
The New Times for more information).

How can I be sure I’m going through menopause? If you are in your
late forties or early fifties, are having the symptoms mentioned above, and
your periods or changing or have stopped, it is highly likely that menopause is
occuring. It is important to consult with a physi- cian you trust, either a
gynecologist or an alternative practitioner such as a naturopath, or both, for
a number of reasons, rather than just going it on your own. If there is
abnormal bleeding, it may be important to rule out other causes besides
menopause, such as cervical, uterine, or ovarian cancer or fibroids, which are
unlikely, but possible. In some cases, it is important to get very specific
information through measuring blood levels of the various types of estrogen ad
of progesterone. New tests are available to measure the amount of bone loss,
preferably during the first year after menopause, when up to 30% of the loss is
said to occur. Menopause is a very literally a change of life which
necessitates your making some choices. If you choose to take hormones, you need
regular gynecologic care. If you choose not to, there are definite dietary,
vitamin/mineral, and lifestyle recommendations which are very important for you
to integrate into your life. Choosing simply to avoid the issue entirely and
hope that all works out for the best is, in my opinion, not a responsible
option.

What about hormones for menopause? The use of estrogen replacement
therapy (ERT) for women who have reached menopause with at least one ovary is
quite controversial and a very personal decision on the part of each woman.
Opinions on the subject range from the vehemently anti-hormone philosophy
espoused in Women and The Crisis in Sex Hormones by Seaman to the
attitude that, “Of course, you need to take hormones” of orthodox
gynecologists. I would estimate that 30 to 40% of my women patients
experiencing menopause choose to take estrogen. ERT is usually effective in
eliminating or improving hot flashes, vaginal dryness (often in conjunction
with a vaginal estrogen-containing cream), night sweats as well as preventing
osteoporosis. It may not address other symptoms such as wrinkling, aging, and
psychological concerns.

In the mid-70’s, by which time ERT had been very popular for ten or
fifteen years, research began to indicate that ERT in post-menopausal women
could increase the risk of uterine cancer

fivefold. There followed a dramatic decrease in the use of ERT. More recently,
evidence has shown that the use of progestin, a hormonal supplement similar to
the natural hormone progeste-rone, for l0 to l4 days at the end of each 25 day
regimen of estrogen is protective against uterine cancer. Estrogen is now
available in a number of different preparations as well as both orally and in
patches, which have the definite advantage of bypassing the liver.If you decide
to go ahead and use ERT, consider the various forms carefully before deciding.
Menopause Naturally provides good information on this subject. Some of
the disadvantages of ERT are continued monthly periods, as least for a while,
the need for regular gynecologic visits, the expense of the hormones, and the
possibility of uterine cancer, liver or gall bladder disease, high blood
pressure, clots, strokes, and depression. Though progesterone does lower the
incidence of uterine cancer, it also can predipose to weight gain and may be
implicated in high blood pressure, stroke, heart disease, and breast cancer.

Be sure to get all the information before deciding one way or the other
about hormones. Similar to deciding whether to receive immunizations, it’s a
very personal decision with possible consequences way after the actual decision
is made. Menopause can be a natural process rather than a disease. Many women
got along quite well through menopause before the intro- duction of estrogen
replacement and still do in many cultures. The philosophy that “every woman
needs to continue having periods in order to stay healthy after menopause and
avoid osteoporosis” is, I feel, absurd.

What about osteoporosis? Osteoporosis is a demineralization of the
bones which occurs after menopause to a serious degree in about 25% of white,
Asian, and brown-skinned women. Black women have thicker bones, which puts them
much less at risk for osteoporosis. This softening and weakening of the bones
is what causes the fractures we often hear about in older women. Many women are
very cautious about falling and breaking a hip; however if a woman has severe
osteoporosis, her bones can break anytime, even from just walking across the
room. It is possible to assess your risk level of osteoporosis through such
tests as DPA (dual-photon absorptiometry) which measures the density of bone in
the vertebrae of your lower back, or a CT scan, which offers the same results
but has a consequence of greater exposure to radiation, as well as through an
X-ray of the bones of the hand. These tests may be current state of the art,
but still do not offer a really accurate predictor of risk of osteoporosis. A
cruder method is to measure your height a year or two after menopause and
compare it to your former height.

There are some definite steps you can take to decrease your risk of
osteoporosis. Women who are slim with small muscle mass, particularly if they
are short, are at increased risk. SO, in this case, it’s actually good to keep
a little extra fat on your bones. This is because estrogen is stored in fat
cells. This is not to suggest, however, to gain a lot of weight, which would
increase your incidence of heart disease. Other factors which increase your
risk of osteoporosis are a history of repeated, easily broken bones, a family
history of osteoporosis, menopause prior to age 40, daily use of cortisone ,
thyroid, Dilantin, or aluminum-containing antacids, renal dialysis, or chronic
ciarrhea or surgical removal of part of the stomach or small intestine. There
is clear evidence that women with a low protein intake decrease their risk. The
best thing you can do for yourself, especially, but not only, if you prefer not
to take ERT, is to eliminate red meat from your diet. Taking the next step of
avoiding chicken and fish, also animal proteins, further decreases your risk.
Other ways to lower your risk are to avoid or minimize alcohol and caffeine,
not smoke, minimize salt, exercise regularly, and be sure to supplement calcium
and vitamin D.

What if I don’t choose to take hormones? There are several
important considerations if you choose not to take hormones which, I feel, is a
very viable option. First, what is your risk of osteoporosis? If it is
extremely high or you are unwilling to follow the recommended dietary and
lifestyle recommendations, estrogen may be your best bet. In my experience, hot
flashes are not difficult to treat. Vitamin E (assuming you don’t have high
blood pressure) may work for you). If not, constitutional homeopathy is
extremely effective. Vaginal dryness often responds to Vitamin E suppositories.
Several of my patients have recommended a product called Slippery Stuff, which
I know nothing about, to ease their vaginal dryness during intercourse. I
always assess a woman’s Ayurvedic body type (a 5000 year-old, extremely
comprehensive form of medicine from India)to individualize recommendations for
menopause. There are also a number of herbs which have estrogenic (Burdock,
Sage, Dong Quai, Cimicifuga, and others) or progesteronic (Licorice, WIld Yam,
Smilax) properties. Supplementation with a high-quality multi-vitamin and
mineral, calcium (best in the form of calcium citrate which is significantly
better absorbed than other forms of calcium), vitamin D, and boron (a trace
mineral which has been shown recently to significantly reduce urinary excretion
of calcium and magnesium and to cause an increase in serum beta-estradiol, a
form of estrogen). It is important for women not on estrogen, particularly
those who don’t follow the above dietary recommendations carefully, to take
between l200 and l500 mg. of calcium daily, preferably half with meals
(hydrochloric acid stimulates calcium absorption) and halfat bedtime (because
phytates, found in some high complex carbohydrates, interfere with calcium
absorption). It is important to realize, however, that calcium supplementation
by itself, has not panned out, in recent studies, to significantly prevent
osteoporosis. Magnesium increases calcium absorption and should also be taken
daily. I also use another supplement containing Vitamin K and parathyroid which
further enhances calcium absorption. Regular aerobic exercise for at least 20
minutes 4 to 5 times a week is, for post-menopausal women, an absolute
necessity to prevent osteoporosis. It can also be very helpful to support the
woman’s liver during this time, since the liver is responsible for breaking
down estrogen and a sluggish liver will make estrogen less available in the
body. This can be done through herbs, lipotrophic factors, and liver
cleansing.

The psychological and spiritual aspects of menopause. The
post-menopausal years can be a truly wonderful and gratifying period of a
women’s life, maybe even the best ever. It is a time, for most women, when they
no longer have to attend to children and can focus more love and attention on
themselves and their own needs. There is no longer the concern about becoming
pregnant, which is a relief to many women, and make make sex a freer
experience. And there is the opportunity to enjoy the fruits of one’s
professional, personal, and spiritual wisdom. In India, the time when one’s
children are grown is considered the beginning of sanyas or
renun-ciation for men or women who so choose. They are encouarged to spend the
rest of their life seeking their Oneness with God. If you find yourself, during
or after menopause, filled with despair, resentment, fears about the future,
get help so that this can be the beautifully rewarding change in your life that
you have waited for and so fully deserve.

Dr. Judyth Reichenberg-Ullman and Robert Ullman is a naturopathic and
homeopathic physician and cofounder of the Northwest Center for Homeopathic
Medicine in Edmonds, WA. She is coauthor of The Patient’s Guide to
Homeopathic Medicine and Beyond Ritalin: Homeopathic Treatment of ADD
and Other Behavioral and Learning Problems. She can be reached at (206)
774-5599.