Some women sail through menopause like they’re traversing the calm waters of Walden Pond. You know who you are. First, your periods seem to be changing a little–shorter, longer, irregular, but overall not worth much thought. Then one day you realize you haven’t had one in months.
“Well,” you think to yourself. “That was a piece of cake. What’s the big deal?” And surely you don’t miss the cramps, the worry about bleeding onto a conference room chair at work, or those mood swings. Given the number of women who are living well into their 80s and 90s, it’s a safe bet you’ve got decades of smooth sailing in front of you.
For a second group of menopausers, the waters are a bit choppier. Once or twice a day you feel a totally unexpected wave of heat (“Was that a hot flash?”). Maybe a couple nights a week you awaken from dreaming that you’re trapped in a Dutch oven, your nightgown drenched, pillow sponging sweat from the back of your head. Maybe your brain is a wee bit foggy, too, your sex drive more of a memory. (Well, perhaps a fictionalized memory. Most of us are historical revisionists when it comes to sex.)
If you’re in this mid-range menopause group you may need just a bit of help, but certainly no intervention from Mayo Clinic. Moderate menopause symptoms are fairly easy to treat naturally, without hormone therapy. I’ll get into the specifics of that a bit later.
Members of the third group are facing Industrial Strength Menopause, clinging to their tiny sailboats as they’re battered about in a stormy sea of miserable symptoms, which, if gender transfer could be arranged, would bring most men to their knees. By their 50s, virtually all women are familiar with their devilish hormone shifts, uncharted territory for men. After a couple of drenching night sweats and a day at the office babbling with brain fog, sweat dripping onto his keyboard, you’d need to take a guy experiencing this kind of menopause to an emergency room where he could explain his symptoms to a resident.
(“Oh, don’t worry, sir. It’s just menopause. We’re seeing more and more of it these days in men. We think it’s the GMOs. We can’t put you on Premarin now, can we? Just live with it.”)
The lucky ducks in the first group need no treatment at all. Best not to discuss menopause with them. Your envy could trigger a hot flash.
If you’re in either the “I can live with it” Group Two or the “Get me out of here!” Group Three, you have a lot of options. Just about every woman troubled by the symptoms of menopause can either reduce them to an acceptable tolerability or zero them out altogether.
In her book The Wisdom of Menopause Christiane Northrup, MD, offers two very sensible pieces of advice. First, your choice of treatment is your own, not your doctor’s. And second, don’t attempt to eliminate every last hot flash. Regard the leftovers as daytime power surges.
Herbs are the least expensive, simplest treatment for mild-to-moderate menopause symptoms. The mainstay is black cohosh, which our apothecary carries in the form of the best-selling Menopause AM/PM by Integrative Therapeutics. After years of research, no one has yet figured out exactly how black cohosh works. Since menopause symptoms are caused by declining estrogen levels, you’d assume black cohosh was an herbal estrogen. But it doesn’t show any estrogenic activity. Sometimes we just have to accept the unknown.
Tried and true menopause relief replaces flagging hormones themselves. Conventional doctors prescribe Premarin or Prempro, the latter Premarin + progesterone, in the hope that the concentrated urine of a likely now-dead but once pregnant horse (PREgnant MARe urINe–get it?) is just what your body craves. More convenient and certainly tasteful are the new estrogen skin patches (Vivelle-Dot, Climara) and these do work, but they should be used along with oral progesterone because so-called unopposed estrogen (estrogen therapy without progesterone) increases your uterine cancer risk.
At WholeHealth Chicago, if you’re going the hormone route we recommend you use bioidentical hormones. Available in capsules or skin creams, bioidenticals are manufactured from soy. They’re called bioidentical because they’re biologically identical to the hormones your own ovaries have been making throughout your life. By using bioidenticals, we’re trying to re-create the hormonal milieu of you at about age 30. A typical capsule contains two estrogens (estradiol and estriol), progesterone, and if you’ve got a libido issue, some testosterone for seasoning.
Bioidenticals are the mainstay of compounding pharmacies, and (pardon my cynicism here) because they help women, are safe and effective, and aren’t products of Big Pharma, many–though not all–health insurance companies fabricate a variety of excuses to avoid paying for them.
And now for some fresh good news. Well, not at all news to us at WholeHealth Chicago, but news to most conventional medical professionals.
Acupuncture works for hot flashes. Believe me, if back in the WholeHealth Chicago practitioner’s lounge I held up a journal and blurted, “Hey, everybody–look at this! A medical journal reports that acupuncture works for hot flashes!” I’d get dagger stares from Mari Stecker, Cindy Kudelka, and Helen Strietelmeier.
Mari would be the first, “David, are you doctors out of your minds? What do you think I’ve been doing with these needles for the last 20 years? Needlepoint? Embroidery?!”
But now it’s official. Published this week in Menopause: The Journal of the North American Menopause Society, researchers reviewed a total of 104 previous studies in which acupuncture was used to treat menopause symptoms. Twelve of the studies, with a total of 869 participants, met the inclusion criteria for this effort. Articles like these are called meta-analyses, meaning researchers review older studies, mine the data, and take a second look. Why re-invent the wheel? Twelve well-conducted studies with nearly 900 participants are sure to tell you something.
And they did.
Acupuncture works for hot flashes, night sweats, and menopause-related symptoms like low libido, brain fog, mood issues, and vaginal dryness. Interestingly, the effects were also fairly long lasting. Once symptoms were brought under control, the benefits lasted about three months. Returning symptoms were milder and could be brought back under control with additional treatments.
Although bioidentical hormones are considered very safe, many women worry about taking any hormones. With health insurance no longer covering bioidenticals, and reimbursement for acupuncture treatments appearing more often as an added benefit, acupuncture for your menopause symptoms may actually turn out to be a more economical choice than hormones. And absolutely safe.
David Edelberg, MD