When I entered menopause over 15 years ago, helping women do so naturally was an art not yet practiced. Fortunately, that is no longer the case as the damning chorus against synthetic hormones has become impossible to ignore.

 I was aware that time of my life was probably approaching, and well before the hot flashes actually began, started some evasive strategies. I recommend this approach, because planning ahead can in many women significantly ease the extent of the problem once it actually sets in with full discomfort. My strategy was to use more soy foods (see below), add a combination of phytoestrogenic herbs  ( containing substances which mimic estrogen in the body, exerting an effect comparable to about 2% of estrogen itself (Werbach) ),  increase my vitamin E intake, and try to learn how to cope with stress. I did this for about two years during a period formally designated peri-menopause.

It is interesting to note that almost everyone is aware that in the Orient, women until now have had very little problem with the discomforts of menopause, and occasionally, very rarely, here in the U.S. I will meet a woman who has had an uneventful passage . The main reason given for this difference is the greater consumption of soy foods in oriental cuisine, and I acknowledge that there may be some truth to this: I have used a soy protein for my morning drink as a source of both energy and isoflavones for nearly 20 years: however, it is definitely not the whole reason for the difference. (Additionally, I should point out that much of the soy used in the Orient is fermented, and if you have low thyroid function, or find that using plain soy protein decreases rather than increases your energy level, you should probably look for a protein that is fermented, like the Jarrow product I now use.) 

As a lead-in to specific recommendations to control the physical manifestations of the problem, such as hot flashes, night sweats, mood swings, depression etc., I want to make sure you realize that supporting our general health and lowering (or instituting coping mechanisms for) stress levels, is also an important part of dealing with menopause. Many health problems, some of which are governed by our hormones, surface after the change of life,. and changing over to a more healthy and moderate lifestyle at this point can make a vast difference in the quality of our later years.

An important element for female health is exercise. Such choices as Yoga and T'ai Chi Chuan are perfect for flexibility, relaxation, muscle tone and mood. While Yoga is preferred for joint problems - I have heard it referred to as an oil can for the joints - Tai Chi promotes strength in the lower body, which is very helpful for circulation, and balance,  often a problem as we age. One Tai Chi Master in his 90s, still a daily practitioner of the art, told me that having strong legs into old age is like having a second heart! I believe that YMCAs have classes in both these exercise forms, and there are also tapes and books available for those who wish to teach themselves. Some women prefer running, but those of us who do have to realize that there is an element of physical stress involved with this choice that has to be addressed: running makes you fit, makes you feel good, but it can be a negative if the additional nutritional demands it makes on the body are not met.

Second in importance is changing our diet: there can be no argument that most women benefit greatly from emphasizing a more vegetarian diet after menopause, with plenty of fresh fruits and vegetables, and lighter sources of protein. A metabolism that once was able to handle greasy foods and extremely high carbohydrate intake is greatly impaired by it after a certain age - when you think about it, there are not many overweight old women around: either they have lost their weight by that point, or ill health has exacted its due. Obesity is almost always caused by faulty diet: one does not get fat on oxygen! Either too much sugar, too much fat, too little fiber, lack of exercise, the wrong foods for one's body or a combination of all these factors is to blame, and after the change, we do not have the resources to spare to maintain health and cope with the disastrous effects of poor food choices. Losing those extra pounds is something that must be done, and the payoff is well worth it. I urge you to identify your problem and correct it! One of the major reasons the problem of overweight desperately needs to be addressed as women age is that adipose tissue produces estrogen. Dr. Cohen (of the Dana Institute of the American Health Foundation) is of the opinion that pre-cancerous lesions in breast tissue only develop into malignancies if they are stimulated by certain agents, one of which is fat! Remember, obesity is one of the risk factors for breast cancer, and now you know why. This is also why smoking is more of a problem for women as they age:  tobacco has an effect on estrogen.

If you are trying to lose weight by limiting the fats you eat, be aware that certain fatty acids are essential for controlling both hormonal balance and depression - among other things! Be sure you are getting adequate amounts of Omega 3s, either from Fish Liver Oil, Primrose Oil, or (less effective in my opinion, but still helpful) Flax Oil.

I have also noted, both personally and in my clients, that sensitivities to allergies become more extreme with age, which at its simplest may have to do with bowel flora diminishing, and decreased production of digestive enzymes. 

I was amused to read a column in a newspaper recently reporting  that some of the big pharmaceutical companies are marketing a hormone cream based on Wild Yam: it was presented as a big, radical advance - but Dr. Lee formulated just such a cream based on research he was doing in 1978!  I myself used it for many years starting in 1985. Recent studies which appeared in the American Journal of Obstetrics and Gynecology, and Obstetrics and Gynecology showed that an appropriately formulated transcutaneous progesterone cream has a pharmacologically significant effect on blood hormone levels, and that 83% of women using just the cream experienced relief from their hot flashes, either totally or to a meaningful degree. The studies were done using Dr. Lee's Pro-Gest, which is the cream I used for my passage, but there are now a selection of creams made using his formula. See Resources on right for choices. Note that I stopped using hormone creams once my menopausal discomforts were in the past, about 5 years  in all.

 However, it now appears that Testosterone levels are the ones to watch in order to protect yourself from postmenopausal cardiovascular disease:  Researchers in the Am J Epidemiol  2002;155:437-445.  state "Estrogen levels may not be as important as testosterone levels with regard to risk of atherosclerosis in postmenopausal women not using hormone replacement therapy," and  add that the findings "support further exploration of the potential benefit of adding androgen therapy to hormone replacement therapy in postmenopausal women with androgen deficiency as a way to modify cardiovascular outcomes." 

Some women find the addition of testosterone gel handy to counter the loss of libido sometimes suffered at this time, but I strongly suggest measuring your levels before you try this. (see RESOURCES for a simple kit.)

In addition, there is now preliminary evidence that adding soy and flax to our diets will be cardioprotective,  A Dutch study found that even slightly higher than "usual" consumption of these foods ,made arteries more flexible, and aortic stiffness is strongly predictive of cardiovascular events. (Arterioscler Thromb Vasc Biol 2002;22:1316-1322.)

A British study (Diabetes Care 2002;25:1709-1714.) has shown that even short-term use of dietary phytoestrogens significantly and positively affects fasting insulin levels, insulin resistance, HbA1c levels, total cholesterol levels, LDL cholesterol, cholesterol/HDL cholesterol ratio, and free thyroxine (thyroid function) levels. The investigators concluded that even short term supplementation  with soy phytoestrogens  ( though it was not clear whether the soy protein itself, or its component isoflavones are responsible for the effect) reduces insulin resistance and improves glycemic control in type 2 postmenopausal diabetics.

Chief among the herbs I recommend is Dong Quai, or Angelica Sinensis, which has been used in Chinese Traditional medicine for centuries to promote women's health. Foster and Chongxi's book, Herbal Emissaries, describes it as not only important for a number of purely female problems, but also as a circulation enhancer, tranquilizer and liver protectant. I also rate Licorice very highly, and I speak here of the standardized herb, containing glycyrrhizin. This means two things: one, a 1994 study ( Soma et al, Endocrine Regulation 1994; 28:31-34) showed that it inhibits the breakdown of Cortisol (an adrenal hormone important in stress regulation) and two, it should not be used by anyone susceptible to high blood pressure or water retention, since high doses can adversely affect these conditions. At one point, I was greatly helped by a Glandular Extract of Adrenal , called Sub-Adrene,  combined with Pantothenic Acid and Licorice.

A great deal of research has been focused on extracts of Black Cohosh, or Cimifuga Racemosa. Dr. Michael Murray reports on a large open study involving 131 Doctors and 629 patients: within 4 weeks of the start of therapy, "most patients reported noticeable benefits within four weeks .... after six to eight weeks, complete resolution of symptoms were reported in a high number of patients" Side effects were so few as to be negligible. Additional benefit may be derived from using this extract, since studies suggest it may HALVE the risk of breast cancer!

Here I would note that the most unpleasant side of menopause for me was hands down the insomnia.  I tried everything I could think of, but still would awaken with a start an hour after I fell asleep, and then every hour or two throughout the night. Finally I came across the suggestion that high Cortisol levels from Stress could cause this effect, measured my levels (see Resources, right) found them off the chart and began to implement some stress control measures. What worked for me was Phosphatidyl Serine, which reduces Cortisol levels, Ashwaganda as an adaptogen, and the Sub-Adrene mentioned above.  The final solution was the Serotain-RX Sleep, by Nature's Plus. taken with a liquid mixture of Magnesium before bedtime.  It seems a lot to have to do to sleep, but I was absolutely desperate at this point, not having slept through the night for nearly 7 years.  Anything that worked, was my policy!!  Now that l-Tryptophan is available again, it has become my number one choice.

and I have no hesitation in stating, based on my own experience and that of many women I know, that the combination of diet, exercise, herbs, nutrients and transdermal creams is one that works in almost every case, without risk and without (or very rarely an allergy type problem) side effects.

Synthetic hormone replacement has become an extremely controversial subject. It is a decision every woman has to make for herself, but for many the choice was made clear by  well-publicized reports in 2002 of negative side-effects with the use of synthetic hormones.  Many of the people who recommend synthetics  are not people who have actually faced the problem personally, and there I have the advantage: I can tell you what my decision was: to use naturally occurring hormone sources.

The touted benefits of conventional Hormone Replacement Therapy - control of hot flashes, relief of depression, protection against osteoporosis and maybe cardiovascular disease, are all things I knew I could achieve through diet, exercise and supplementation: the possible risks of HRT - breast cancer, blood clots weight gain, migraines, depression- these I could do without!  And as if those risk factors weren't enough, researchers in Britain are now saying that women on synthetic HRT are 3 times more likely to develop gallbladder problems.  Gallstones being composed primarily of cholesterol,  the use of estrogen possibly  promotes an increase in cholesterol in bile, which  leads to gallstone formation.

Worst of all, evidence is now surfacing to suggest that long term use of estrogen may increase the risk of Alzheimer's Disease. Granted this was a study in rats - but when you consider how often positive results in rat studies are used as justification .... (Behav Neurosci 2002;116:902-911.)

July 2002 - well, the cardiovascular disease is no longer a "maybe":
"This follow-up study found no reduction in risk of heart attacks or death for women with heart disease during up to seven years of hormone therapy," lead author Deborah Grady, MD, MPH, from the University of California, San Francisco, says in a news release. "Not only was there no cardiovascular benefit, there were adverse affects, including blood clots and gallbladder disease."

HERS was a randomized, blinded, placebo-controlled trial of estrogen plus progestin in older postmenopausal women with heart disease. Contrary to expectation, risk of myocardial infarction (MI) increased during the first year of HRT, although risk seemed to decrease during the remainder of the study, which lasted 4.1 years. The HERS II follow-up open-label study, lasting 2.7 years, was therefore designed to evaluate the effects of longer-duration HRT.

In HERS, 2763 postmenopausal women with coronary heart disease, average age 67 years, received either 0.625 mg/d conjugated estrogen plus 2.5 mg medroxyprogesterone acetate, or placebo. During the HERS II follow-up, the women chose whether to take hormones based on advice from their personal physicians.

The initial trend from HERS suggesting a reduced risk of MI with longer duration of HRT did not persist with additional follow-up. Combining HERS and HERS II, there was no risk reduction from HRT during almost seven years.

In fact, HRT doubled the risk of thromboembolism in the legs and lungs, with most of the increased risk in the early years of treatment, and increased the risk of gallbladder disease requiring surgery by 48%. There was no benefit of HRT for any other major disease outcome including overall risk of death

In the United Kingdom, the government was so unconvinced of the benefits of estrogen for heart disease (which is generally the justification for using it despite the risk of breast cancer) that their latest advisory brochure contained this language:  "Initial results from a large ongoing trial suggest that, in women who already have heart disease, HRT does not have a beneficial effect on heart disease, at least in the short term. In fact your risk of heart disease may be slightly increased in the first year of use," ........however, because these trials are still ongoing, the long-term effect of HRT on heart disease will not be known for several years. It is also not known whether HRT reduces the risk of heart disease in healthy women."

Of interest here also are studies presented in 1999 at the annual meeting of the American College of Cardiology showing that postmenopausal women who already have heart disease may increase their risk for myocardial infarction and angina if they use hormone replacement therapy. Researchers were not clear why this should happen, but speculated that synthetic estrogen plays a part.

The accepted theory all this time has been that the extraordinarily low rates of heart disease in young women was due to hormonal protection:  however, another theory which makes more sense to me, is that the blood-letting of the menstrual cycle each month keeps IRON levels low in pre-menopausal women.  For a complete report on this, follow the link in RESOURCES at right.

Links of interest
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Very Important:
MisInformed Consent
please go here before agreeing to a hysterectomy.

A December 2000 report which showed signs of things to come

Confused about
anti-oxidants and
your health?
A disinterested analysis of the studies.

Researchers now report that women who take estrogen-only hormone replacement therapy (HRT) for a long period of time have a higher-than-average risk of developing ovarian cancer. Read Dr. Mercola's comments.

Follow this link for the report on IRON'S effect on pre-menopausal cardiovascular health.

The effects of HRT on OUR bodies isn't all we need to worry about:  concentrations of synthetic hormones
are affecting our water sources.

Antibiotics and common medications are also a problem.

A Network for Women,
by Women,
about Natural Progesterone Use
 

Testosterone deficiency in Women.
 

This takes you to a site called www.the clitoris.com, which has useful information about female libido. 
Be aware: It is very frank and open.

Related articles you may find interesting:

• Osteoporosis
• Essential Fatty Acids

• Stress and the Adrenals