A Natural Approach to Menopause

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A Natural Approach to Menopause

JoAnn Guest

Apr 27, 2006 14:50 PDT

 

 

http://www.pcrm.org/health/prevmed/menopause.html

 

Every day, in hundreds of doctors' offices, the same conversation

takes place between women going through menopause and their doctors.

The doctor writes out a prescription for estrogen pills or patches,

saying they will replace the hormones her body ought to be making.

They will cure her hot flashes, slow her bone loss, and reduce her

risk of a heart attack. The patient asks if the pills cause cancer.

The doctor acknowledges that there is an increased risk of uterine

and breast cancer, but argues that the benefits to the heart and

bones are worth taking the chance.

 

Other risks enter into the discussion: strokes, blood clots, and

water retention, among others. Women who have seen friends or

relatives die of cancer or stroke might not find this very

reassuring. They may have menopausal symptoms, and they would like a

solution. But they are looking for something safe, that doesn't

cause more problems than it solves.

 

Take heart: there are dietary steps, other lifestyle changes, and

natural hormone preparations that can make menopause much more

manageable. They are better for your heart and bones than estrogen

prescriptions could ever hope to be, and they accomplish these

things without the side effects of estrogens.

 

Premarin is a commonly prescribed estrogen preparation from Wyeth-

Ayerst Laboratories. Although doctors sometimes describe it

as " natural " for women, it is actually a horse estrogen. On farms in

North Dakota and Canada, 75,000 mares are impregnated and then

confined from the fourth month through the end of their eleven-month

pregnancy so their urine can be gathered in a collection harness

called a " pee bag. " After they give birth, the mares are

reimpregnated. Their foals usually end up as horse meat, and the

urine estrogens are packed into pills. The trade name " Premarin " is

simply a condensation of the words " pregnant mares' urine " —hardly a

natural substance for human beings to swallow. While Premarin

contains estradiol and estrone, two types of estrogen which are made

in humans, it also contains an enormous amount of equilin, a horse

estrogen that never occurs at all in humans.

 

Estrogen supplements increase the risk of blood clots and can cause

high blood pressure, gallstones, vaginal bleeding, nausea, weight

gain, breast tenderness, skin discolorations, headaches, and

depression. They also increase the risk of uterine and breast cancer

and make existing cancers much more aggressive. Women taking

estrogen supplements have 30 to 80 percent more breast cancer risk

than other women.1-3

 

If progesterone is added to the regimen, it removes the increased

risk of uterine cancer, although it does not counteract the higher

risk of breast cancer. Synthetic progestins have side effects of

their own, sometimes causing breast tenderness and fluid retention,

and making depression worse.

 

So why are so many doctors prescribing them? Partly to treat

menopausal symptoms. But more of the push for estrogens relates to

osteoporosis and heart disease. Happily, there are healthier

solutions for both problems.

 

Natural Changes

At around age 50, the ovaries stop producing estrogens. The adrenal

glands (small organs on top of each kidney) continue to make

estrogens, as does fat tissue. But the ovaries have produced the

greatest share of the body's estrogens for decades, and when they

quit, the blood levels of estrogens drop dramatically.

 

Many women go through this change feeling fine, both physically and

psychologically. Nonetheless, some women are bothered by symptoms,

including hot flashes, depression, irritability, anxiety, and other

problems.

 

There Is No Japanese Word for Hot Flashes

It has long been known that menopause is much easier for Asian women

than it is for most Westerners. In a 1983 study, hot flashes were

reported by only about 10 percent of Japanese women at menopause,

compared to about two-thirds of women in America and other Western

countries.4 And bone strength is not assaulted to the extent it

often is among Western women. Broken hips and spinal fractures are

much less common.

 

The most likely explanation is this: throughout their lives, Western

women consume much more meat and about four times as much fat as do

women on Asian rice-based diets, and only one-quarter to one-half

the fiber. For reasons that have never been completely clear, a high-

fat, low-fiber diet causes a rise in estrogen levels. Women on

higher-fat diets have measurably more estrogen activity than do

those on low-fat diets. At menopause, the ovaries' production of

estrogen comes to a halt. Those women who had been on high-fat diets

then have a violent drop in estrogen levels. Asian women have lower

levels of estrogen both before and after menopause, and the drop

appears to be less dramatic. The resulting symptoms are much milder

or even non-existent.

 

More evidence of the diet link comes from a fascinating study by a

medical anthropologist from the University of California who

interviewed Greek and Mayan women about their experience of

menopause.5

 

The Greek women were subsistence farmers. Menopause occurred at an

average age of 47, compared to over 50 in the United States. About

three-quarters had hot flashes, but they were considered normal

events, however, and did not cause women to seek medical treatment.

 

The Mayan women lived in the southeastern part of Yucatan, Mexico.

Menopause occurred earlier than in Greece or North America, at an

average age of 42. Unlike the experience of Greeks and Americans,

hot flashes were totally unknown among Mayans, and, like the

Japanese, they have no word for them. Midwives, medical personnel,

and the women themselves reported that hot flashes simply do not

occur, nor are they mentioned in books on Mayan botanical medicine.

 

The difference between Americans and Greeks and other Europeans on

the one hand, for whom hot flashes are common, and the Mayans and

Japanese on the other, for whom they are rare or unknown, appears to

be diet. The Mayan diet consists of corn and corn tortillas, beans,

tomatoes, squash, sweet potatoes, radishes, and other vegetables,

with very little meat and no dairy products. Like the traditional

Japanese diet, it is extremely low in animal products and low in fat

in general. The Greek diet, while rich in vegetables and legumes,

also contains meat, fish, cheese, and milk, as does the cuisine of

other countries in Europe and North America. Animal-based meals

affect hormone levels rapidly and strongly, and undoubtedly

contribute to the menopausal problems that are common in Western

countries.

 

Treating Hot Flashes

For women who are experiencing hot flashes, there are useful steps

in addition to the low-fat, vegetarian diet which is strongly

recommended for so many reasons. Regular aerobic exercise helps. A

vigorous walk every day or so, or any equivalent physical activity,

seems to alleviate hot flashes.

 

Andrew Weil, M.D., a well-known physician and author, recommends

trying the herbs dong quai, chaparral, and damiana, two capsules of

each taken once daily at noon, or, if used as a tincture, one

dropperful in a cup of warm water. Vitamin E, in doses of 400 to 800

IU per day, has also been reported to be helpful. People with high

blood pressure should use no more than 100 IU per day. Jesse Hanley,

M.D., a family practitioner in Malibu, California, has found that

certain Chinese herbs, called Changes for Women, by Zand Herbal, and

Menofem, by Prevail, are helpful in reducing menopausal symptoms for

some women. These supplements are available at most health food

stores.

 

For those women who are considering hormone supplements, some

preparations may be safer than others. Estrogens that are commonly

prescribed by physicians contain significant amounts of estradiol,

which is one of the forms of estrogen that has scientists and many

postmenopausal women concerned about cancer risk. A different

estrogen, estriol, appears to be safer. The best evidence indicates

that estriol does not increase cancer risk.6-9 Plant-derived

transdermal creams containing estriol and smaller amounts of other

estrogens are available without a prescription. The estrogens pass

through the skin and enter the blood stream, reducing menopausal

symptoms. Creams containing pure estriol must be ordered by doctors,

not because they are more dangerous (they are not), but because the

process of concentrating them qualifies them as drugs, rather than

natural preparations.

 

Dr. Hanley finds that a mixture of plant-derived estrogens and

progesterone is often helpful. Transdermal creams containing

estriol, estradiol, estrone, and natural progesterone are very

effective in reducing hot flashes.

 

Regrettably, less research has been done on the use of estriol,

compared to estradiol. Even though there is no evidence of cancer

risk with estriol, Dr. Hanley recommends that if any estrogen cream,

including estriol, is used, that it be accompanied by progesterone

to reduce the risk of uterine cancer, and that it be monitored by a

physician so it can be tailored to a woman's individual

needs. " Whatever formula is used, it should have some progesterone

in it, " Dr. Hanley said. " Also, women should cycle their hormones.

The cream is used from day 1 to day 26 of the cycle, followed by 4

to 6 days off. " If additional natural progesterone is used, it

should be added for the final two weeks (days 13 to 26) and stopped

together with use of the cream.

 

Natural progesterone alone helps reduce symptoms for some women.

Progesterone and estrogen creams are available from Professional

Technical Services (800-648-8211), Women's International Pharmacy

(800-279-5708), or Klabin Marketing (800-933-9440).

 

Natural Solutions for Dryness

At menopause, vaginal blood flow falls. Dryness and irritation can

occur, and bacteria infections that pass to the urinary tract are

more likely.

 

What is to be done? First of all, even after the ovaries stop, the

adrenal glands and the fat tissue continue to contribute to estrogen

production after menopause. In addition, phytoestrogens in plants

provide weak estrogen effects. Soy products, such as tofu, tempeh,

and miso, contain huge amounts of these natural compounds.

 

The plant-derived estrogen and progesterone creams described above

can be helpful. Used on a regular basis, these creams maintain a

moist vaginal lining. They should not be used as a sexual lubricant

however, as an older couple learned the hard way. A letter to the

editor of the New England Journal of Medicine described a 70-year-

old man who developed an enlarging left breast.10 He went to see his

physician who removed the mass. Several months later, the same thing

happened on the right side. It suddenly struck him that his wife was

using a vaginal estrogen cream, not only twice a week to treat

vaginal dryness, but also as a sexual lubricant two or three times

per week. As gratified as his doctor may have been to learn that

this older couple was still maintaining frequent conjugal bliss, the

doctor had to conclude that the estrogen cream had caused the man's

breast enlargement. They switched lubricants and his enlarged breast

went away. Estrogen cream is a medication, not a lubricant, and it

goes through any skin it touches. Many women prefer to avoid hormone

creams entirely and use ordinary lubricants or moisturizers instead.

 

The Psychology of Menopause

Hormone shifts can affect moods. To the extent that these shifts are

smoothed out by dietary steps, psychological effects are more

manageable. Here are the most common psychological accompaniments of

menopause:

 

Anxiety. Women who have never had a problem with anxiety before may

become more self-conscious and more worried about minor events. In

some cases, panic attacks occur. Mental health professionals have a

variety of effective treatments. Many people feel much better just

knowing what the condition is.

 

The most important piece of advice is not to let anxiety restrict

your activities. When anxiety or panic disorders cause people to

avoid stressful situations, the result can be an ever-tightening

leash that keeps them from enjoying life. Anxiety can lead to

avoidance of many aspects of normal life. Prompt treatment prevents

this.

 

Depression and Irritability. Depression seems to be particularly

common when menopause is medically induced, e.g., after removal of

the uterus and ovaries because of illness. Irritability is also

common.

 

To the extent that depression, irritability, or anxiety need

treatment, it is important to explore the full range of available

options. The first step is to get your diet in order and to get

regular exercise to help stabilize hormone shifts and reduce

physical symptoms that can aggravate mood problems. Psychotherapy

can be very useful, and new short-term techniques have demonstrated

their effectiveness at considerably less investment than is demanded

by traditional therapies. New anti-depressants and antianxiety drugs

have emerged in the past years which have fewer side effects than

older medications.

 

Poor Memory and Concentration. Some women find that menopause brings

occasional memory lapses, often related to reduced ability to

concentrate. This can be upsetting and annoying, but happily it

seems to go away on its own with time.

 

Keeping or Restoring Strong Healthy Bones

Osteoporosis—thinning of the bone tissue—is common, particularly

among Caucasian women, after menopause. The cause is not an

inadequate calcium intake, ordinarily. The problem is abnormally

rapid calcium loss, aggravated by the following five calcium

wasters:

 

1. Animal protein. When researchers feed animal protein to

volunteers and then test their urine a little later, it is loaded

with calcium, which comes from their bones. Here's why. A protein

molecule is like a string of beads, and each " bead " is an amino

acid. When protein is digested, these " beads " come apart and pass

into the blood, making the blood slightly acidic. In the process of

neutralizing that acidity, calcium is pulled from the bones. It ends

up being lost in the urine. A recent report in the American Journal

of Clinical Nutrition showed that when research subjects eliminated

meats, cheese, and eggs from their diets, they cut their urinary

calcium losses in half.11 Switching from beef to chicken or fish

does not help, because these products have as much animal protein as

beef, or even a bit more.

 

2. Sodium (salt). If you throw salt on a slippery sidewalk, it

dissolves the ice; if you sprinkle it on your food, it can dissolve

your bones, albeit by a different mechanism. Salt apparently

increases calcium losses via the kidneys. For an average person,

cutting sodium intake in half reduces the daily calcium requirement

by about 160 milligrams.12 Grains, vegetables, fruits, and beans are

very low in sodium unless salt is added to them. Snack foods, canned

foods, dairy products, and meat tend to drive up the amount of

sodium in the diet.

 

3. Caffeine. Whether it comes in coffee, tea, or colas, caffeine is

a weak diuretic that causes calcium loss via the kidneys.13

 

4. Tobacco. Long-term smokers have 10 percent weaker bones and a 40

percent higher risk of fracture.14

 

5. Sedentary lifestyle. Bones that have nothing to do lose their

strength.15

 

Healthy Calcium Sources

When you eliminate these calcium-wasters, you need less calcium in

your diet. However, you will always need some calcium. If you get

very little calcium, say, less than 400 milligrams per day, you may

not be giving your body the calcium it needs.

 

Although many people try to get their calcium from milk, only about

30 percent of calcium in dairy products is absorbed. The remaining

70 percent never makes it past the intestinal wall and is simply

excreted with the feces. Milk products also contain lactose sugar,

animal proteins, and frequent traces of antibiotics and other

contaminants.

 

The healthiest calcium sources are " greens and beans. " Green leafy

vegetables are loaded with calcium. One cup of broccoli has 178

milligrams of calcium. What's more, the calcium in broccoli and most

other green leafy vegetables is more absorbable than the calcium in

milk. An exception is spinach, which tends to keep its calcium to

itself. Beans, lentils, and other legumes are also loaded with

calcium. If you make green vegetables and beans regular parts of

your diet, you'll get two excellent sources of calcium.

 

You don't need to eat six cups of broccoli or huge servings of beans

to get enough calcium. A varied menu of vegetables and legumes can

easily give you all you need, and the amount your body needs is far

less when you steer clear of meats and the other calcium-depleters.

The World Health Organization recommends a daily calcium intake of

just 400 to 500 milligrams per day.

 

If you decide to add extra calcium, calcium-fortified orange juice

is a good choice. It contains more calcium than milk, and it is in

the form of calcium citrate, which is much more readily absorbed

than that in milk or in calcium carbonate supplements.

 

HEALTHFUL CALCIUM SOURCES

(content in milligrams)

Source Amount

 

Black turtle beans (1 cup, boiled) 103

 

Broccoli (1 cup, boiled) 178

 

Brussels sprouts (8 sprouts) 56

 

Butternut squash (1 cup, boiled) 84

 

Celery (1 cup, boiled) 54

 

Chick peas (1 cup, canned) 78

 

Collards (1 cup, boiled) 148

 

Corn bread (1 2-ounce piece) 133

 

English muffin

92

 

Figs, dried (10 medium) 269

 

Great northern beans (1 cup, boiled) 121

 

Green beans (1 cup, boiled) 58

 

Kale (1 cup, boiled) 94

 

Kidney beans (1 cup, boiled)

50

 

Lentils (1 cup, boiled) 37

 

Lima beans (1 cup, boiled)

52

 

Navel orange (1 medium) 56

 

Navy beans (1 cup, boiled) 158

 

Onions (1 cup, boiled) 58

 

Orange juice, calcium-fortified (1 cup) 300*

 

Pancake mix (1/4 cup, 3 pancakes) 140

 

Pinto beans (1 cup, boiled) 82

 

Raisins (2/3 cup) 53

 

Soybeans (1 cup, boiled) 175

 

Sweet potato (1 cup, boiled) 70

 

Tofu (1/2 cup) 258

 

Vegetarian baked beans (1 cup) 128

 

Wax beans (1 cup, canned) 174

 

Wheat flour, calcium enriched (1 cup) 238

 

White beans (1 cup, boiled) 161

 

Source: J.A.T. Pennington, Bowes and Church's Food Values of

Portions Commonly Used. (New York: Harper and Row, 1989.)

* package information

 

Sunlight

As sunlight touches the skin, it turns on the natural production of

vitamin D, which helps your digestive tract absorb calcium from

foods and makes your kidneys hold onto it as well. For those who get

infrequent sun exposure, any common multivitamin containing 5

micrograms (200 IU), taken daily, provides adequate vitamin D. For

people who never go outdoors due to chronic illness, 10 micrograms

(400 IU) is recommended. Higher doses of vitamin D can be toxic and

should be avoided.

 

Restoring Strength to Bones

Natural progesterone stimulates the bones to rebuild healthy bone

tissue in areas where it has been lost. Unlike estrogens, it has no

known serious side effects. In a study of 100 postmenopausal women,

the average patient had a 15 percent increase in bone density after

three years of treatment.16 What makes this so remarkable is that

doctors have been looking for ways to slow the rate of bone loss,

and most never dreamed it would be possible to actually build bone.

But an increasing number of clinicians are finding exactly

that.17,18

 

Altered forms of progesterone, called progestins (e.g., Provera),

are heavily promoted by drug companies and are commonly prescribed

by doctors. But these unnatural chemicals do not quite fit into the

body's systems for using and eliminating progesterone. They are the

biological equivalent of using the wrong replacement part in your

car's engine. While the pharmaceutical companies' financial

machinery hums along just fine, your biological machinery can have a

multitude of side effects, ranging from facial hair growth and

depression to heart disease, liver problems, and even breast cancer.

The body was built to use natural progesterone, not inexact copies.

 

Here is how natural progesterone is used: Usually, a two-ounce jar

is used up each month. Later, the dosage may be reduced to one ounce

per month. In postmenopausal women, the cream is usually used each

month for two to three weeks, then stopped until the beginning of

the next month. In women who have not yet stopped menstruating, the

cream is usually used from about day 13 to day 26 of the menstrual

cycle. To maintain its effect, it is discontinued for at least five

to seven days each month.

 

It is spread on areas of thin skin, such as the insides of the arms

or legs, the neck, upper chest, and abdomen, covering as wide an

area as possible and varying the areas to which it is applied. It

takes a while for progesterone to build up in the fat tissue, so it

may take two or three months to be effective.

 

Because progesterone facilitates the effects of thyroid hormone,

women taking thyroid medications may need to reduce or discontinue

their thyroid medications after beginning progesterone, which should

be done in consultation with their doctors.

 

Postmenopausal women who are taking estrogens are often advised to

cut their estrogen dose in half when starting progesterone, because

progesterone temporarily increases the body's sensitivity to

estrogen. Many women find that they no longer need estrogen at all

after a few months using the progesterone cream.

 

Women who are currently using an artificial progestin, such as

Provera, can easily switch to natural progesterone, but should taper

off the progestin gradually. A typical regimen would be to cut the

progestin dose in half for the first month that progesterone cream

is used. In the second month, it should be cut in half again, using

it every other day, if necessary. By the third month, the progestin

can be safely discontinued.

 

While prescription estrogens are sometimes used to reduce the risk

of heart disease, a combination of a vegetarian diet, daily modest

exercise, smoking cessation, and stress reduction is much more

effective, and has been shown to actually reverse existing heart

disease in 82 percent of patients. And while estrogens increase

cancer risk, these healthy lifestyle changes actually reduce the

risk of cancer and several other illnesses.

 

References

1. Colditz GA, Stampfer MJ, Willett WC, et al. Type of

postmenopausal hormone use and risk of breast cancer: 12-year follow-

up from the Nurses' Health Study. Cancer Causes and Control

1992;3:433-9.

2. Yang CP, Daling JR, Band PR, Gallagher RP, White E, Weiss NS.

Noncontraceptive hormone use and risk of breast cancer. Cancer

Causes and Control 1992;3:475-9.

3. Bergkvist L, Adami HO, Persson I, Hoover R, Schairer C. The risk

of breast cancer after estrogen and estrogen-progestin replacement.

N Engl J Med 1989;321:293-7.

4. Lock M. Contested meanings of the menopause. Lancet 1991;337:1270-

2.

5. Beyene Y. Cultural significance and physiological manifestations

of menopause: a biocultural analysis. Culture, Medicine, and

Psychiatry 1986;10:47-71.

6. Follingstad AH. Estriol, the forgotten estrogen? JAMA 1978;239:29-

30.

7. Heimer GM. Estriol in the postmenopause. Acta Obstet Gynecol

Scand 1987;Suppl 139:3-23.

8. Molander U, Milsom I, Ekelund P, Mellstrom D, Eriksson O. Effect

of oral oestriol on vaginal flora and cytology and urogenital

symptoms in the post-menopause. Maturitas 1990;12:113-20.

9. Gerbaldo D, Ferraiolo A, Croce S, Truini M, Capitanio GL.

Endometrial morphology after 12 months of vaginal oestriol therapy

in post-menopausal women. Maturitas 1991;13:269-74.

10. DiRaimondo CV, Roach AC, Meador CK. Gynecomastia from exposure

to vaginal estrogen cream. N Engl J Med 1980;302:1089-90.

11. Remer T, Manz F. Estimation of the renal net acid excretion by

adults consuming diets containing variable amounts of protein. Am J

Clin Nutr 1994;59:1356-61.

12. Nordin BEC, Need AG, Morris HA, Horowitz M. The nature and

significance of the relationship between urinary sodium and urinary

calcium in women. J Nutr 1993;123:1615-1622.

13. Massey LK, Whiting SJ. Caffeine, urinary calcium, calcium

metabolism and bone. J Nutr 1993;123:1611-4.

14. Hopper JL, Seeman E. The bone density of female twins discordant

for tobacco use. N Engl J Med 1994;330:387-92.

15. Mazess RB, Barden HS. Bone density in premenopausal women:

effects of age, dietary intake, physical activity, smoking, and

birth-control pills. Am J Clin Nutr 1991;53:132-42.

16. Lee JR. Osteoporosis reversal; the role of progesterone.

International Clin Nutr Rev 1990;10:384-91.

17. Prior JC. Progesterone as a bone-trophic hormone. Endocrine Rev

1990;11:386-98.

18. Prior JC, Vigna Y, Alojado N. Progesterone and the prevention of

osteoporosis. Canad J Ob/Gyn 1991;3:178.

 

This article is condensed from Eat Right, Live Longer, by Neal D.

Barnard, M.D., Harmony Books, 1995.

_________________

JoAnn Guest

mrsjo-

www.geocities.com/mrsjoguest/Genes