Approaching Menopause
By Carolyn Weisswasser, ND

There are as many ways to approach menopause as there are individual experiences of it. In fact, menopause is defined by irregularity. For some women it may be as simple as a cessation of their menstrual cycle whereas others experience any number of symptoms such as mood swings, hot flashes and skin changes. Some women find that dietary changes and exercise provide adequate relief while others need botanical medicines or hormone replacement therapy (HRT) to relieve their symptoms. Menopause is also the beginning of a new phase of life with fewer obligations and new opportunities and adventures. With proper care and understanding menopausal women can be healthy and happy and use this time period as an opportunity to foster a preventative health care plan and lifestyle.

Although a woman is not truly menopausal until one year after her last menstrual period she may be perimenopausal (around menopause) for five to ten years prior to the cessation of menstruation. Perimenopause is marked by changes in the menstrual cycle such as shorter intervals between periods, missed periods and possibly symptoms such as fatigue and low libido. These symptoms are related to sporadic ovulation and waning levels of the ovarian hormones estrogen and progesterone. Most women begin perimenopause between 46 and 48 years; Eighty percent of women begin menopause between 50 and 52 years, according to the Women’s Health Initiative study (WHI).

The most common complaint of early menopause is the hot flash, a feeling of extreme warmth that can wake women from sleep. Seventy-five percent of women experience hot flashes, although only fifteen percent are severe. Other common complaints include headaches, insomnia, urinary tract infection, vaginal changes, mood swings, depression, anxiety, concentration and memory problems. As estrogen levels decline a women’s risk of heart disease and osteoporosis rises. My advice is for all women to be evaluated by a health care provider, not only for menopausal issues but to address general health and prevention of chronic disease.

The first place to start in achieving hormone balance after menopause is to establish a healthy diet. A low-fat, high-fiber diet with healthy proteins (legumes, seeds, nuts) and plenty of colorful fruits and vegetables forms the foundation for health. Particularly beneficial are soy beans and flax seeds. Soy beans (tofu, tempeh, soy milk) and flax seeds contain phytoestrogens, or plant estrogens. These are very weak estrogens that mildly stimulate estrogen receptors in the body and help to relieve the symptoms of low estrogen. This ability has raised concerns amongst some people that soybeans could increase the risk of cancers fueled by estrogen, such as breast cancer. However, there is no evidence of this effect and to the contrary it appears that soy foods lower the risk of breast cancer. Isolated soy extracts such as the isoflavones genestein and diazeidin have not been adequately studied and should be avoided by women who have had breast cancer. In the meantime it is safe to enjoy soy beans and flax seeds in their whole and natural forms.

If adopting a healthy diet and including soy foods has not proved sufficient – don’t worry! There are lots of nutritional and herbal supplements that you can safely use. These include: Vitamin E, bioflavonoids (plant pigments) such as hesperedin, gamma-oryzanol (rice bran) and herbs such as red clover, don quoi and black cohosh. Vitamin E (400 IU per day) and black cohosh (40 mg standardized extract per day) have the best record of success amongst Naturopathic doctors, for treating hot flashes. Red clover contains phytoestrogens, like in soy beans. Contrary to previous thinking black cohosh does not contain phytoestrogens; the mechanism of its effect is unknown. Although there is no known toxicity of black cohosh some people do experience side effects such as dizziness, nausea and headaches. Always advise your health care provider when starting a new nutritional or herbal therapy.

One last option for women to consider for the relief of menopausal symptoms is HRT. The decision to use hormones is a complicated one that must take into account factors such as general health (mental, emotional and physical), breast cancer history and treatments, risks (osteoporosis, heart disease, others) and priorities, values, fears and finances. The advantages of hormone replacement include quick and effective relief of menopausal symptoms. HRT also has a preventative benefit against osteoporosis and colon cancer. The disadvantages include an increased risk of breast cancer, heart disease, stroke and gallbladder disease (gallstones). The Women’s Health Initiative study, the largest and most comprehensive study of middle aged women, found that conventional hormone replacement therapy increased women’s risk of heart disease and breast cancer by up to 100 percent. Conventional hormones included in this study were conjugated equine estrogen (premarin) and synthetic progesterone (provera). The arguable contention is that the difference between equine and synthetic hormones and human hormones contributes to some of the problems with HRT. Natural or bio-identical hormones offer a potentially safer alternative as well as many more options for individualized dosing and formulations. Bio-identical hormones are derived from yams or soy beans and are made into hormones that exactly match the human body’s estrogen and progesterone, unlike conventional HRT. Preliminary studies suggest that bio-identical do not have the same risks as conventional HRT. More studies are needed to determine exactly what risks are included with their use.

Women who do not find adequate relief from dietary changes, nutritional and herbal supplementation will need to see a licensed care provider who preferably is educated in the range of hormone options, not just conventional HRT. Remember that any decision you make whether or not to use HRT is not permanent, you can change your decisions over time. Menopause, aging and our concerns over long-term health problems evolve over time. Menopause is a normal and natural event of aging. It can be a time of strength, empowerment, personal growth and positive, life changing insights.

About the author: Dr. Carolyn Weisswasser is a licensed Naturopathic Doctor specializing in women’s health care and chronic disease. She practices at Whitewater Naturopathic Medicine in Grass Valley, CA. For more information call (530) 271-7123 or visit www.whitewaternaturopathic.com

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