Menopause is a natural transition in a woman’s life that occurs generally from ages 45-55 years. Many would consider menopause as a significant rite of passage. Unfortunately, however, for many women, their overwhelming powerful physical and emotional symptoms can destroy this most important event. One knows that hormonal imbalances are the underlying cause of such emotional disturbances when there are no obvious triggers or reasons for feeling this way.
Menopause occurs when a woman’s ovaries begin to diminish in their function. In doing so, they are unable to supply the sex hormones, such as oestrogen, progesterone and testosterone, in the manner to which a woman has been accustomed to since the age of puberty.
If all is well, generally the adrenal glands should take over the function of the ovaries such that she should ideally breeze through this change. This is unfortunately not the case for many women who also suffer with adrenal exhaustion.
What symptoms does a woman normally experience?
As mentioned above, some women experience no symptoms or signs of menopause other than a lack of periods. A woman is not truly “menopausal” until they have experienced no periods for 1 year. Periods often become erratic for some time before this and may also change in their duration and heaviness. It is important to make sure your pap smears are up to date in order to exclude any other possible causes.
Other symptoms of menopause may include hot flushes and/or night sweats, palpitations, insomnia, low libido, fatigue, hypertension, dry vagina and lack of skin elasticity.
One important note here is that there are no signs or symptoms of bone loss, hence a Bone Mineral Density around 50 years or when hormones begin to change is advised.
What is the problem with Hormone Replacement Therapy (HRT)?
HRT has been used for many decades to treat the symptoms of menopause. However, alarming results of the Women’s Health Initiative Trials (over 26,000 women) has dramatically changed HRT prescribing throughout the world.
These trials have shown that the risks of breast cancer (with combined oestrogen and progestogen) and endometrial (uterine) cancer (with oestrogen only in women with a uterus) increase with the duration of HRT therapy.
Both oestrogen only and combined HRT also increase breast density and abnormal mammography, which is a concern of itself.
The risk of coronary heart disease, blood clots and strokes may also be elevated in the first year of combined HRT in women over 60 years. In this same post-menopausal age group, there has also been shown there are no benefits in the case of cognition, dementia or reduced mortality.
It is also important to note that combined low-dose oral contraceptives can be assumed to have similar risks to HRT for women older than 40 years.
How do Bio-identical Hormones differ to normal HRT?
Bio-identical Hormones are derived from plant sources (primarily Mexican wild yam) as opposed to the oestrogens in HRT that are derived from the urine of pregnant horses. Unlike HRT, B-HRT includes hormones that are biologically identical to those found naturally in the female body (eg. Progesterone compared with Progestogen).
These hormones are compounded and should be customised to each individual woman’s needs. They may include combinations of oestrogen, progesterone, testosterone and DHEA (adrenal gland hormone) and come in a variety of forms, the most common of which are buccal troches (like lozenges).
What is there so little evidence regarding Bio-identical Hormones?
As for many complementary therapies, there is currently limited evidence regarding the efficacy and safety of B-HRT compared with conventional HRT. However, it should be known that B-HRT has been used for at least 40 years with only 3 cases of endometrial (uterine) cancer having been reported for women taking B-HRT (including progesterone, dose unknown) for several years.
Many integrative doctors use B-HRT rather than conventional HRT in their clinics if the use of hormones is definitely required. Although formalised studies are limited, there is overwhelming anecdotal evidence from women and clinical experience by integrative doctors that the correct and judicious use of B-HRT is both safe and effective.
So should you use Bio-identical Hormones?
Most integrative practitioners would agree that any form of hormonal therapy should only be used when absolutely necessary, HRT or Bioidentical.
Often a 6 -12 week trial of a particular herb and/or nutrient combination is trialled before hormones are prescribed.
Please consult your individual practitioner with regards to such formulations as many “Practitioner-Only” formulations are considerably more effective than simple over the counter preparations.
Why may an Integrative Practitioner not want to use Bio-identical Hormones?
Unfortunately, as there are no current in depth studies of B-HRT, its use is a grey area of care, which extends itself to the medico-legal implications of usage.
It is often assumed that the risks of B-HRT are equivalent to that of synthetic HRT, yet this has never been scientifically established. Although there have been suggestions of a link between B-HRT and endometrial cancer risk, this concern has been raised based upon a single source of evidence reporting 3 apparent cases.
Until these issues are resolved, B-HRT usage will remain a contentious issue amongst both integrated and mainstream practitioners. Before using B-HRT, you should be personally responsible for understanding the issues its prescription presents and you may need to sign a disclaimer documenting that you understand the issues of using B-HRT (including the risks) before a practitioner is prepared to use them.
Are there Nutritional/Herbal therapies that may be of assistance?
As for most things in life (and certainly in medicine), there is no single therapy that will definitely assist all women. Most herbal and/or nutritional regimes are of at least 6-12 weeks duration in order to properly assess the effects of such therapies.
Despite the limited evidence currently available for nutritional and/or herbal therapies, integrative therapists have used a variety of regimes successfully- we would advise a trial of these is certainly preferable to the use of any hormonal therapies in order to manage debilitating symptoms.
There is currently equivocal evidence with regards to the efficacy of black cohosh. Hepatotoxicity (liver damage) has been reported, although black cohosh was allegedly not the only substance being used in these instances.
There have also been some studies on red clover extract and soy isoflavone extracts which have shown mixed results with regards to hot flushes. No short-term adverse effects have been identified.
Dong quai may have oestrogenic effects and has shown in-vitro proliferation of breast cancer cells. As such, it should not be used in breast cancer or other oestrogen sensitive conditions. Dong quai, red clover extracts and ginseng may also interact with warfarin, hence INR should be closely monitored.
What Eating Plan should you use?
As menopause is a natural change of life, the Optimal Healthy Eating Plan is a sensible approach. Of course if any other Medical Condition exists, you should follow whatever Eating Plan is most suited.
What about a Structured Weight Loss Programme?
If you are overweight, can join a structured weight loss programme and truly commit yourself to this, this may well be successful. Whatever the dietary approach, structured programmes often reinforce commitment through peer support, critical to the success of many weight loss attempts.
Are there any Superfoods you should eat more of?
Foods that help with hormonal regulation are thought to include:
Broccoli, Cauliflower, Cabbage (raw or lightly cooked)
Leafy greens, bananas, nuts and seeds (high Magnesium foods)
All other high fibre foods
Moderate intake of natural soy foods if you are tolerant to them
Omega 3 fish; Salmon, Tuna, Mackerel, Sardines, Herring
Seaweed (high in Iodine)
How about exercise?
Regular exercise should be maintained during menopause to encourage healthy hormonal balance. Furthermore, women approaching middle age should be encouraged to continue exercise as a means of preventing or limiting progress towards Osteoporosis.
Aim for between 30 and 60 minutes per day of mixed exercise including exercise in weight bearing positions.
This is probably the most significant change you can make in your life if you are a smoker. If you cannot quit without assistance, this being the majority of smokers, it may be sensible to join a multidisciplinary programme. Peer support is often essential to the success of any quit smoking plan.
Remember, although pharmaceutical approaches that replace nicotine via chewing gum, patch or otherwise are often helpful, eventually they must be weaned otherwise you may simply be trading the risk of lung cancer for other diseases.
Is sleep important?
Healthy sleep patterns are important for all hormonal imbalances as hormonal regulation follows regular daily cycles (circadian). If you have irregular or unhealthy sleep patterns, seek to normalise these (see Sleep Health section by Clicking this link).
How does stress affect Menopause?
Stress affects all hormonal imbalances through the physiological stress response. If you are experiencing stress in your life, managing this can be an important contribution to hormonal balance.
What should I consider doing about this?
Identify the reason for your stress. Any of the following interventions may be appropriate depending upon your own individual circumstances.
Such interventions may include:
Relaxation and Meditation independent or as part of a Yoga programme
Other Effects Based Stress Managements techniques
Cause Based Stress Management Techniques
Achievi Life Balance
Learning to effectively manage Emotions
Prioritising Family and other Relationships (including healing old wounds)
Becoming connected with your community, environment and, if you are spiritual,
the concept of God/Universe that matters to you.