Strictly speaking, menopause is your final menstrual period, but most doctors agree you need 12 straight months without a period before you can call that last period “final.” Gone along with your periods, however, are your “factory-installed” female hormones. These protect you against a host of conditions–heart disease and osteoporosis most prominently–and lack of them can lead to a variety of symptoms, known collectively by your mothers as “the change.” These may include hot flashes, night sweats, mood swings, sleep disturbances, vaginal dryness, weight changes and poor concentration.
What you are now faced with is the decision of the Nineties and the new millennium: Is hormone replacement therapy (HRT) right for you? What you need to remember, however, is that every woman passing through menopause has different needs. Not everyone, for instance, is at risk for heart disease or osteoporosis. And indeed there are effective, safe, nonhormonal ways to bolster yourself against these conditions without HRT.
Our approach at WholeHealth Chicago is to leave the final decision of HRT up to you. But we do suggest that you try some of our recommendations first and see how they can help.
What is Menopause?
Menopause is the natural process in a woman’s life that occurs when the ovarian hormones estrogen and progesterone gradually decline. The lack of hormones eventually halts her monthly menstrual cycle, and the ovaries stop releasing eggs. A woman who hasn’t had a menstrual period in 12 months is said to have reached menopause, although menopausal symptoms can actually begin from 1 to 12 years earlier while she’s still having periods, a time frame commonly called perimenopause. Menopause itself typically occurs between the ages of 45 and 55, or on average about age 52. Although certainly not a disease, menopause is the gradual decline in estrogen that can produce some unpleasant symptoms in some, but certainly not all, women. These include hot flashes and night sweats; mood swings, irritability, or mild depression; an inability to concentrate; urinary urgency and frequency; vaginal dryness with painful intercourse; and sometimes a loss of interest in sex.
Changes in body chemistry occur as well. The bones lose calcium, and osteoporosis (brittle bones) may develop. Blood pressure and cholesterol and homocysteine levels can all rise, increasing a woman’s risk for developing heart disease.
- Absence of menstrual periods for at least six months
- Hot flashes (a sudden sense of heat in the face, neck and upper back lasting less than a couple of minutes)
- Night sweats (which may interfere with sleep)
- Irritability, nervousness, or depression
- Poor concentration or memory
- Vaginal dryness with painful intercourse
- Loss of interest in sex
- Urinary urgency or frequency
- Stress urinary incontinence
- Increased incidence of urinary tract infections (UTI)
- Heart palpitations
- Bloating or water retention
What Causes Menopause?
Menopause means the ending of menstrual periods and for most women, the cause is simply a normal phase of her life, when estrogen production declines. The age that menopause starts usually coincides with the age menopause occurred in her mother or older sisters. Surgical menopause begins after a total hysterectomy, when both the uterus and the ovaries are removed.
Treatment and Prevention Most conventional physicians prescribe hormone replacement therapy (HRT) for virtually all women entering menopause, whether or not they are experiencing symptoms. Their reasoning is that HRT will supply enough estrogen to prevent any of the uncomfortable symptoms of menopause, prevent osteoporosis (thus reducing the risk of hip and spinal fractures), and lessen the risk of developing atherosclerotic heart disease.
However, even though HRT is popular in America, physicians from other countries regard it as controversial because of certain side effects, including headaches, bloating, irritability, breast tenderness and increased risks of developing blood clots or gall bladder and liver disease.
Physicians familiar with alternative options regard each woman as a unique individual and do their best to avoid the “one size fits all” thinking of their more conventional colleagues. If a woman has symptoms of menopause or is at risk for heart disease or osteoporosis, they may begin by suggesting dietary changes, nutritional supplements and herbs. They may recommend such therapies as an exercise program, acupuncture, yoga, aromatherapy or homeopathy. And if a woman really needs HRT, physicians may suggest gentler natural hormones that can be individually compounded to meet her specific needs instead of automatically turning to traditional hormone replacement therapy.
The herbs, vitamins and minerals suggested here may also help lower the risk of heart disease and osteoporosis after menopause.
Just a reminder: If you have a serious medical condition or are taking medication, it’s always a wise idea to talk with your doctor before beginning a supplement program.
How Supplements Can Help
Black cohosh, a relative of the buttercup, has long been prescribed to treat menstrual problems, including hot flashes and vaginal dryness. It does so by suppressing luteinizing hormone (LH) which is released by the pituitary gland. High levels of LH are considered to be one of the causes of hot flashes. Black cohosh also contains phytoestrogens, plant compounds that imitate the body’s own estrogen. These phytoestrogens may help with symptoms of vaginal dryness. Additionally, they may actually prevent breast cancer by keeping the body’s own estrogen away from breast tissue. Adding some vitamin C and flavonoids can help reduce mood swings.
Siberian ginseng has been used for centuries in China as a general tonic for both men and women. This all-purpose herb not only helps relieve stress, boost mood, enhance immunity and increase mental alertness, but it may also alter hormone levels and reduce some of the symptoms of menopause. It is best used in combination or rotation with other herbs, and some caution may be needed as it can increase blood pressure.
Chasteberry, the fruit of the chaste tree (often called Vitex), is frequently recommended by European doctors to help with both PMS symptoms and hot flashes. Although the berry does not contain any hormones, it acts on the pituitary gland, the master gland in the body that controls the levels of hormones from the ovary.
Dong quai is often referred to as the “female ginseng.” Although it is not a phytoestrogen and doesn’t have any hormonelike effects on the body, this herb seems to have a balancing effect on the female hormone system. Like ginseng, dong quai is referred to as an adaptogen, a substance that can help increase energy, reduce the body’s response to stress and enhance both physical and mental capabilities.
Soy isoflavones act as phytoestrogens and seem so potent that they not only prevent or relieve typical symptoms of menopause such as hot flashes and night sweats but also may prevent atherosclerotic heart disease and osteoporosis. Most of the research on soy has been done with women who ate soy products regularly, so foods such as soy milk and tofu are probably a good bet. Alternatively, the major isoflavones of soy, genistein and daidzein are now available in capsule form.
The essential fatty acids found in evening primrose and borage oils help regulate natually occuring hormonelike chemicals called prostaglandins. They can help control the irregular menstrual bleeding so common during menopause, including heavy or scant flow and cramping.
Other supplements that may be helpful for reducing risks from heart disease and osteoporosis include vitamin E, calcium, magnesium, and vitamin D. Vitamin E stimulates the body’s estrogen production and, as one of the antioxidant vitamins (along with the carotenes and vitamin C), acts to prevent LDL (“bad”) cholesterol from precipitating along the inside of artery walls. Calcium, magnesium, and vitamin D help prevent osteoporosis and are often combined into a “bone-building” supplement. Even women on HRT should evaluate their calcium, magnesium, and vitamin D intake to make sure they are getting enough.
Get supplement dosages and tips in our WholeHealth Chicago Supplement Recommendations for Menopause.
Get regular exercise, which promotes heart health. Strength training with light weights protects bone strength.
Increase your intake of calcium-rich foods and vitamin D to promote healthy bones.
Regular intercourse increases the tone and lubrication of vaginal tissues. Products such as K-Y Jelly and Replens can improve vaginal lubrication. Your doctor can prescribe an estrogen-based cream as well.
Avoid alcohol, coffee, chocolate and spicy foods, all of which may worsen your hot flashes.
Practice deep breathing exercises, which have been shown to reduce hot flashes by 50%.
The essential oil clary sage, either inhaled or added to a hot bath can help relieve hot flashes.
Take frequent soaking baths in tepid water, just a little cooler than body temperature.
When to Call a Doctor
- If you think you have risk factors for heart disease or osteoporosis.
- If natural remedies fail to adequately relieve your menopause symptoms.
From David Edelberg, M.D. at WholeHealth Chicago: Most menopausal symptoms can be handled nicely with lifestyle changes and nutritional supplements. To begin, you’ll need a high-potency multivitamin as well as a good calcium/magnesium/vitamin D combination to prevent osteoporosis. And ask your doctor about a DEXA bone-density scan to help determine if hormone replacement therapy (HRT) would be beneficial.
If you opt not to do HRT, you can use the additional supplements in the chart to control hot flashes and other symptoms. The supplements are safe to take as long as symptoms persist.
How to Take the Supplements
Start with black cohosh, a hormone stabilizer considered among the most reliable herbs for menopause. If your symptoms are especially uncomfortable, add either the chasteberry or an herbal combination product. The latter alone may be fine if your symptoms are mild, and you only need minimal doses of the various herbs.
You can also add two more herbs: Siberian ginseng, which helps reinforce your physical and emotional energy, and dong quai, which seems to enhance the effects of other herbs. Both of these are widely used worldwide. If your symptoms still don’t respond, move on to the topically applied natural progesterone cream.
Eating plenty of soy products may reduce your symptoms, improve your cholesterol profile, and lower your blood pressure. Soy isoflavone capsules are a reasonable alternative if you don’t want to consume soy.
Recent studies have shown that antioxidant vitamins can be beneficial for menopause, too. In particular, vitamin E helped reduce the risk of heart disease (naturally heightened after menopause) by keeping LDL (“bad”) cholesterol from adhering to artery walls.
The essential fatty acids found in flaxseed oil help stabilize hormonal shifts so prevalent in menopause. The oil’s also a source of omega-3 fatty acids, which protect against heart disease and breast cancer, and it may reduce some menopausal symptoms.
Two other herbs have also proved to be helpful for certain menopausal symptoms. Ginkgo biloba can be beneficial for women with menopausal-related concentration or memory problems. And St. John’s wort has a long track record as a safe, effective remedy for the melancholy and depression that plague some women as their estrogen supply declines.
Of special note:
Adding a bone-building formula (two pills twice a day) can be a positive protective step against osteoporosis-induced fractures, and it’s particularly important during menopausal years.
If you’re suffering from mercurial mood shifts, unpredictable anger, anxiety, and nervous tension, kava (250-500 mg 2 or 3 times a day) can truly be an herbal miracle. It works quickly, doesn’t make you drowsy, and improves your focus and concentration.
Sleep disturbances during menopause are extremely common. Melatonin (1-3 mg at bedtime) can be a real lifeline–a safe, effective sleeping aid with no dangers of being habit-forming or addictive. Important:
We at WholeHealth Chicago strongly recommend that everyone take a high-potency multivitamin/mineral and well-balanced antioxidant complex every day. It may be necessary to adjust the dosages outlined below to account for your own daily vitamin regimen. All of our supplement recommendations also assume you are eating a healthful diet.
Be aware that certain cautions are associated with taking individual supplements, especially if you have other medical conditions and/or you’re taking medications. Key cautions are given in the listing below, but you need to see the WholeHealth Chicago Reference Library for a comprehensive discussion of each supplement’s cautions and drug/nutrient interactions.
For product recommendations and orders click here for the Natural Apothecary or call 773-296-6700 ext. 2001.
David Edelberg, MD