Menopause and Perimenopause
The period around menopause
Written by Dr Arien van der Merwe MBChB FRSPH MISMA as an article excerpt from Health and Happiness, the newly revised and edited book written by Dr Arien, published by HSM Publishers, Jan 2013. Please visit www.healthstresswellness.com for more information
Introduction
After a recent letter to Natural Medicine Journal, where the reader emphasised the controversy, confusion and contradicting opinions about menopause, HRT and osteoporosis, I was asked by the Editor, to write an article on the topic.
Most women are aware from a very early age that we eventually have to go through menopause. A woman’s ovaries gradually slow down and stop producing estradiol (the strong oestrogen) and progesterone, usually between the ages of 45 and 50, but it can vary between 40 and 55. The production of oestrogen in the body never stops completely, and the weaker oestrogens, namely estriol and estrone, are also produced in several other organs of the body. The initial symptoms of menopause can be attributed to the sudden decrease in the production of oestrogen and progesterone from the ovaries. The severity and duration of symptoms also depend on various other factors. The period around menopause, is called the peri (around) menopause.
Definition
Perimenopause, also called the menopausal transition, is the interval in which a woman’s body makes a natural shift from mostly regular cycles of ovulation and menstruation, toward permanent cessation of ovulation, or menopause. The perimenopausal period can start at different ages. Signs can be noticed in your 40’s, or even as early as your 30’s. Signs include irregular periods, that may become shorter, heavier or lighter, with sometimes more and sometimes less than 28 day cycles. Menopause-like symptoms such as hot flushes, sleep disturbances, moodiness and vaginal dryness might be experienced. Once you’ve had 12 consecutive months without a menstrual period, you’ve officially reached menopause and the perimenopause is over.
Symptoms associated with menopause
Irregular periods
Hot flushes with night sweats, heart palpitations, nausea and anxiety
Headaches
Fluid retention with swelling and oedema
Tender, painful breasts
Lowered libido and vaginal dryness
Insomnia (aggravated by hot flushes)
Fatigue
Muscle and joint aches and pains
Irritability and impatience
Emotional instability
Depression
Loss of short-term memory
Lack of concentration
Most of the symptoms can be attributed to a progesterone deficiency, sleep deprivation and distress, rather than an oestrogen deficiency. Many factors play a role in the development, severity and duration of menopause. The change in hormone levels is only one of the factors. Heredity, general health, nutritional status, medication, lack of exercise, stressful events in your life (children leaving home, difficult teenagers, financial problems, marriage problems, looking after elderly parents) and your mental-emotional attitude to life, all play their part.
A woman’s body can compensate for the decline in ovarian oestrogen production, by increasing production in other organs (the adrenal glands, liver, fatty tissue and brain). It is mainly the increased emotional and nutritional demands that may put too great a burden on the body and mind. This can aggravate menopausal symptoms.
More than 300 types of tissue in the body contain receptors for oestrogen and progesterone. A marked decrease in the amount of oestrogen and progesterone from the main source (the ovaries) will clearly cause dramatic physical changes.
Symptoms of low oestrogen and progesterone
Genital organs (vagina, vulva, uterus) – vaginal dryness, thin atrophied mucosa and skin, lowered libido, vaginal infections caused by pH change (acid content) in mucosa
Urinary tract (kidneys, ureter, bladder, urethra) – incontinence, infections
Breasts – tenderness, nodules
Skin – dryness, sensitivity
Hair – dryness, hair loss
Mucosa – dryness, airway infections, airway allergies, digestive problems
Skeleton – osteoporosis
Cardiovascular system – hypertension, high LDL-cholesterol, angina, heart attacks, stroke
Pelvic muscles – poor muscle tone in bladder floor with stress incontinence (leakage of urine while laughing, coughing or exercising)
Brain – depression, emotional instability
As during puberty, menopause causes dramatic changes in a woman’s body. The process takes place over a period of one to five years, with menstrual periods becoming less frequent until they stop altogether. Many women do not even realise that they’re going through menopause. Do not expect to get any symptoms. You may be one of the lucky ones!
Natural solutions 1: Coping with peri- and menopausal symptoms
The natural approach to coping with symptoms, is geared towards making the process easier for women rather than stopping the natural process indefinitely. Research has shown that two thirds of women on prescription hormone replacement therapy (HRT) stop taking it within a year because of the side effects.
1. Positive attitude, self acceptance and self care
The single most important factor in managing this important life transition period, is a positive attitude and taking self responsibility for your own health and wellbeing. Stress management and daily relaxation techniques are essential, as well as coming to terms with the fact that you are becoming more mature, and entering a new phase in your life where you will have more time for yourself, your needs and your personal growth and soul development, exploring other aspects of yourself. It is a time of maturation and wisdom. Your reproductive role is over and you can contribute to the community and your family on a deeper level of wisdom and support.
As one reader said in a recent letter to NatMed Jnl: We went on holiday, camping by the sea. It was extremely relaxing and although I was not on any hormones at that time and I even hardly took any of all the supplements I had almost no hot flushes. I think a lot has to do with stress as well.
2. Energy levels
Energy levels may become lower during this time. Try to get enough sleep – 7 to 8 hours a night, in quiet and darkness. Take a morning or afternoon power nap if you have trouble sleeping at night. Special foods that supply plenty of vitamins, minerals and energy include berries, raw honey, red grapes with the pips, spirulina, chlorella, brewer’s yeast, molasses, lecithin and kelp (or marine algae).
3. Water
Drink plenty of water (at least eight glasses a day, or 1 glass for every 10kg in body weight). Water keeps the body young and energetic, with all the biochemical reactions functioning at peak performance. Water also diminishes the cravings for sweet, salt or that indescribable ‘something’ we often feel like having. These cravings often indicate a deficiency of fluids or water in the body.
4. Diet
Ensure that your diet contains fresh, wholesome food, including plenty of fruit and vegetables, wholegrain products, nuts, seeds and pulses. Oatmeal porridge with added oat bran, is a good tonic – it provides fibre (roughage), lowers the LDL-cholesterol and contains many vitamins and minerals. Consume the recommended food throughout the day in six or eight small portions to prevent low blood sugar (hypoglycaemia), which aggravates menopausal symptoms.
Eat fish, poultry, eggs, dairy products, nuts, extra virgin cold pressed olive oil, canola and linseed (flax) oil, as well as lots of pulses (legumes) especially the various coloured lentils, chick peas and soya beans. Avoid refined sugar, white flour, processed foods, processed meats, fried food, saturated (mainly animal) fat, preservatives and too much alcohol. A diet with enough good quality protein and plenty of B-complex vitamins, will support the pituitary gland and hypothalamus, which in turn control the ovaries and the female hormone cycle. This slows down the onset of menopause. Note that women who are strict vegetarians, with a very low cholesterol level, tend to go through an earlier menopause. Remember that cholesterol is also very important for the production of the female hormones. Eat foods that are rich in proteins such as fish, dairy products (low fat yogurt and cottage cheese), eggs, wholegrain products, pulses, nuts and seeds every day.
Foods that contain the B-complex vitamins include green vegetables, wholegrain products, wheatgerm and yeast. Adequate levels of pantothenic acid (vitamin B5), choline and inositol support the adrenal glands as well as the pituitary gland and hypothalamus.
Soya is a rich source of proteins, minerals, vitamins and natural phyto-oestrogens (from plants) that can compensate for the body’s lowered production of oestrogen. These include soya beans, tofu and soya flour. Vegetarian cookery books contain many delicious recipes for tasty soya dishes. You can also mix soya flour with ordinary wholegrain flour. Two of the active ingredients in soya beans, daidzain and genistein, have various functions: they are effective against menopausal symptoms and as antioxidants they protect the body against premature ageing and many diseases such as cardiovascular disease, osteoporosis and cancer. Linseed oil (flax oil) contains plenty of these plant oestrogens. Add the seeds to salads, sauces and sandwich spreads. A tablespoon of ground linseed in a glass of water, is also good for constipation.
5. Calcium supplements
Calcium supplements are essential. It is better to prevent osteoporosis, rather than to wait until there are signs of it. The body’s minimum daily calcium requirement is 1200 mg, which is almost impossible to obtain through diet alone. Your supplement should also contain magnesium, vitamin D (500-1000 IU a day), vitamin C (600-1 000 mg a day), boron (2-3 mg a day) and potassium (150 mg a day) to ensure optimum calcium absorption and bioavailability. Boron also elevates oestrogen levels naturally.
Women should start to use calcium supplements as early as possible, but it is never too late to start. Calcium and magnesium are involved in many functions in the body. Ensuring an additional daily supply prevents the body from taking it from the bones, thereby accelerating osteoporosis. An adequate supplementation dose during menopause would be 900-1 000 mg of calcium a day and 450-500 mg of magnesium a day. The best way to absorb calcium and magnesium is to take it in an amino acid chelation (amino acids are the building blocks of proteins). This ensures optimal absorption in the intestinal tract and bioavailability of these nutrients into the cells. Other good calcium compounds are carbonate or citrate form. Foods rich in calcium that help to ensure strong bones include fish, leafy greens, wholegrain products and dairy products such as yoghurt, cottage cheese, low-fat or fat-free milk.
Calcium and magnesium help for many of the symptoms associated with menopause, especially headaches, anxiety attacks, hot flushes, insomnia and irritability. They also relieve leg cramps, backache and muscular pain. Vitamin D also has many important functions in the body.
6. Other supplements
Other supplements that delay the onset of menopause and alleviate the symptoms include the following:
Vitamin E and selenium protect against cardiovascular disease by reducing platelet aggregation, which can contribute to heart attacks and stroke. They also alleviate hot flushes and delay the ageing process because of their strong antioxidant action. Use up to 800 IU (660 mg) of vitamin E a day at first and, as the hot flushes improve, reduce the dose to 300-400 IU (250-330 mg).
Vitamin C (1 000-2 000 mg in divided doses) also alleviates hot flushes.
Essential fatty acids such as evening primrose oil (1 000 mg a day), linseed oil and salmon oil (500 mg a day) alleviate almost all the symptoms of menopause and prevent the bad LDL-cholesterol levels from increasing. They ensure that the good HDL-cholesterol levels remain high, thereby preventing atherosclerosis (thickening of the arteries).
Chromium (200 μg a day) ensures that the blood sugar levels remain constant, lowers LDL-cholesterol and increases HDL-cholesterol. It also reduces sweet cravings.
Vitamin A (10 000 IU or 3 030 μg or 3 mg of RE activity a day) supports the mucosa and skin. It is a potent antioxidant. Also take beta carotene (25 000 ID or 15 mg a day).
B-complex vitamins (50 mg of B1-B6, 50 μg of B12 and 400 μg of folic acid) support the pituitary gland, the nervous system (depression, irritability and tension) and the female urogenital system.
Iron (15 mg a day) remains important until menstruation stops completely and even for a while afterwards.
Iodine and kelp (marine algae) are important for supporting the thyroid gland that, in turn, improves female hormone function.
Zinc (15 mg a day) helps for depression and supports the female urogenital system.
Natural solutions 2: Coping with peri- and menopausal symptoms
Herbal supplements
Dong quai (Angelica sinensis), or simply angelica, is a popular Chinese herbal remedy that has helped many women. It is used in Chinese medicine as an anabolic (building up) tonic which improves the blood circulation. Angelica itself does not have any oestrogen or progesterone activity, but it improves the body’s own hormone activity. Remember that the female hormones are also produced in the fatty tissue, liver and adrenal glands. Before menopause, 50 per cent of the oestrogen is produced in the ovaries and 50 per cent in the other organs. After menopause, most of the oestrogen is produced in the other organs and the production of ovarian oestrogen declines markedly. The oestrogen produced by the other organs, known as estriol, is a much milder and less potent type of oestrogen than the estradiol produced in the ovaries. Western herbalists and naturopaths often use angelica to treat any disorder of the female urogenital system, such as irregular or painful menstruation (PMS) and menopause. Angelica can be part of a female balance formulation, or can be taken on its own in the form of capsules or as herbal tincture in a little water. Angelica is regarded as the most important herbal remedy for keeping the female urogenital system in balance.
Wild yam (Dioscorea villosa) and fenugreek have a progesterone effect to balance the oestrogen effect of soya beans and calendula. Wild yam is one of the most commonly used herbs in the world. Unlike synthetic progesterone, natural progesterone does not promote virilisation and fluid retention. It can be applied to the body as a cream (face, abdomen, breasts, back and thighs) once or twice a day for 23 days and then five days’ rest or taken in the form of a tea made of the root. It is also available as capsules (about 500 mg a day). The dose can be doubled after two or three months if the symptoms have not cleared up. Progesterone is the most important hormone to supplement during and after menopause. Remember that oestrogen is still made in other organs, but most of the progesterone is made by the ovaries. Natural progesterone from wild yam prevents osteoporosis (some studies claim that it actually reverses osteoporosis). It also helps for vaginal dryness, decreased libido, PMS and painful periods, headache and painful joints.
The phyto (plant) oestrogens and progesterones in soya beans and other herbs protect against prostate cancer in men and various hormone dependent diseases such as breast cancer, endometriosis, fibrocystic breast disease (fibroadenosis), painful menstruation (dysmenorrhoea), absence of menstruation (amenorrhoea), uterine myomas and menopausal symptoms in women. Red clover extract has a similar effect. The phytoestrogens bind to the same receptors as the cancer triggering oestrogen and thereby prevent the oestrogen from initiating the cancer process. I recommend a combination of lifestyle adjustments (stress management, daily relaxation and moderate exercise) with supplements (antioxidant combination, calcium and magnesium supplements, essential fatty acids), soya products and herbs such as angelica, chaste tree berry and wild yam. Wild yam works well in the form of a cream or tablets. The dose can be adapted according to bone density evaluation and effective control of symptoms. It can be used quite safely the right dose is the one that works for you. It can also be used over a long period of time. One source claims up to 120 years – in fact, for a lifetime!
Fennel contains natural plant oestrogen and progesterone. Use it in salads, meat marinades and sauces.
Sage helps for hot flushes. Make a drink of hot water with honey and three drops of essential oil of sage for night sweats. You can make a tea of fresh sage infused in boiling water for a while. For a good night’s rest make a tea of fresh ginger root, sage, camomile, lime blossom and valerian root, with a little honey.
Ginseng helps to improve energy levels and to reduce fatigue.
Chaste tree berry (Vitex agnus castus) helps to alleviate menopausal symptoms. It increases the production of dopamine, a neurotransmitter in the brain. It prevents breast cancer, reduces breast lumps, alleviates oedema, skin problems, vaginal dryness, hot flushes, period pains and restores mental calm. It clearly has a hormonal effect on the body without any side effects.
Ginger improves circulation and acts as a gentle stimulant.
Black cohosh (Cimicifuga racemosa), unicorn root (contains natural oestrogens) and liquorice root are excellent tonics for the female urogenital system. Black cohosh is a well researched herb that is good for many health problems. The North American Indians use it for bronchitis, whooping cough, asthma, rheumatism, insect bites and snakebite. In the West today, it is used mainly for women’s health and particularly for menopausal symptoms. It alleviates hot flushes, vaginal dryness and depression. Black cohosh lowers the levels of the luteinising hormone which is secreted by the pituitary gland, the chief cause of hot flushes. Unlike conventional oestrogen replacement therapy, black cohosh does not interfere with the secretion of the other hormones from the pituitary gland. Women can also use it to alleviate menstrual cramps and for arthritis, neuralgia and tinnitus (ringing in the ears). It is best to take it in capsule form according to the dosages given on the container (usually one capsule twice a day). Black cohosh is a uterine stimulant and should not be taken by pregnant women. It is also contraindicated for women who are breastfeeding because of its oestrogenic effect.
Valerian root helps for anxiety, tension and insomnia.
St John’s wort (Hypericum perforatum) and verbena can be used to alleviate emotional problem such as depression. Ginkgo biloba is excellent for treating depression, memory loss and cardiovascular disease. Garlic also provides excellent protection against cardiovascular disease.
Always get your herbs from a reputable source, or herbal practitioner. If you have some of the herbs in your garden, use the quantities you would use to flavour food or make a tea. Decide what suits you best.
Reduce HRT gradually (taper it): Do not stop taking your hormone medication too suddenly! Reduce the dose gradually over a period of two or three months while you start using natural products. First halve your dose for ten days, then take the half dose every second day for ten days, then every third day for ten days, etc.
The plant progesterones must be taken (or rubbed in) for 23 days and then left for a week so that the receptors remain sensitive to them. If you have already stopped menstruating, this should not start menstruation again, as the application and dosage are too low. Natural plant progesterones improve the effectiveness of the thyroid hormones. Remember to monitor your thyroid medication by having your thyroid stimulating hormones (TSH) levels measured regularly. In due course, you may be able to reduce this medication as well.
It takes a while before herbs and supplements start to work (usually two to three months). Give them a fair chance – be patient!
Natural solutions 3: Coping with peri- and menopausal symptoms
Aromatherapy
Aromatherapy oils are very helpful to alleviate the symptoms of menopause. Essential oils of sage, cypress and geranium improve the physical symptoms of menopause. Keep a mixture at hand to inhale when necessary. You could also add six to eight drops to your bath water. For massaging add 15 drops of each of the essential oils to 100 ml of a carrier oil (almond, coconut, olive or grape seed). Geranium, lavender, grapefruit, camomile, bergamot, neroli, clary sage, vertivert oils and benzoin work well for depression and stress. Add them to your bath water and massage them into the temples, neck or abdomen. Dilute them as described above.
Exercise
Exercise is one of the most important and best ways of alleviating symptoms of menopause and stress. Any form of exercise is good for you. The best exercises are those that improve bone density as well. Walking is the best example. Every woman can find the time in her busy daily schedule to do 20 minutes of walking. Other good exercises include swimming, aerobic exercise, cycling and dancing. Pelvic floor exercises will prevent or retard pelvic muscular degeneration. It is important to do these activities regularly – half an hour five times a week. Exercise also improves symptoms of depression, stress anxiety and the development of atherosclerosis. It ensures a general improvement in health and wellbeing.
Smoking cessation
Besides all the other consequences of smoking, it leads to early symptoms of menopause and accelerates ageing. Please give up smoking! It also increases the risk of developing osteoporosis and cardiovascular disease.
Hormone replacement therapy (HRT)
Hormone replacement therapy (HRT) is a very controversial subject. Some women are in favour of it, but the number of women who are reluctant to commit themselves, is even greater, especially after all the research showing the increased risk for breast cancer, embolism and even endometrial cancer. The purpose of this article, however, is not to discuss HRT, so I recommend that you visit www.healthstresswellness.com for more information on HRT.
There are many steps you can take to manage the onset of peri- and menopausal symptoms, to ease the transition period and at the same time improve your general health and wellbeing, thereby ensuring a life of vitality and longevity, reaching your natural and healthy age of 120-150 easily and joyfully alive!
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