Menopause

What is Menopause

Are you a woman experiencing hot flashes and a disruption in your menstrual cycle? It could be menopause.

A naturally occurring decline of the hormones associated with female fertility, estrogen and progesterone, resulting in the cessation of menstruation. Unfortunately it cannot be prevented and cannot be predicted, but it is not a disease.

The average age of the onset of menopause for most women is 47-51, and it can last 4-5 years.

A combination of clinical symptoms associated with menopause are sometimes called the ‘menopausal syndrome’

It is also known as the climacteric or the change of life. Surgical or artificial menopause may be induced after hysterectomy, radiation or chemotherapy.

Peri-menopause is the time immediately before menopause; menopause or post menopause is the time when menstrual cycles have completely stopped for one year. Most people are talking about peri-menopause when discussing menopause.

Postmenopausal women are more at risk for osteoporosis and cardiovascular disease.

Symptoms of menopausal syndrome

  • menstrual irregularities, hot flashes and night sweats
  • vaginal dryness and thinning, urinary tract infections
  • fatigue
  • decreased libido
  • mood swings, depression and changes in memory and cognition
  • sleep disturbance
  • hair loss on head and hair thinning
  • hair growth and acne of face, skin changes
  • palpitations
  • nausea
  • headaches
Diagnosis and Pharmaceutical Interventions

The diagnosis of menopause is usually clear, based on age and the menstrual history. Hormones levels can be evaluated, in particular follicle stimulating hormone (FSH), which increases as ovarian function decreases, however it is not diagnostic for menopause.

Postmenopausal woman should have regular evaluations for bone density and cardiovascular health.

Pharmaceutical interventions

Hormone Replacement therapy

Hormone replacement therapy (HRT) is the most common treatment for menopausal symptoms. The main pharmaceutical form is conjugated estrogens, with or with synthetic progesterone (progestins). Traditionally conjugated estrogens are obtained from pregnant horse’s urine, i.e. Premarin.

When conjugated estrogens are given alone there is an increased risk of endometrial (uterine) cancer, when given with progestin there is a slight decrease in the risk, but it does not go away.

Although it was originally thought that HRT reduced the risk for cardiovascular disease (stroke, heart attack, embolism, deep vein thrombosis), current research indicates it does not, and can increase the risk.

HRT should not be used for anybody with an active or past incidence of cancer, liver or gall bladder disease

HRT also increases the risk of other conditions such as gall bladder disease, migraine headaches, blood sugar problems and high cholesterol.

Natural Hormone Replacement Therapy

Natural hormone replacement therapy (NHRT), or bio-identical hormones, are natural based hormones made from plants. Natural hormone preparations can be individually prescribed and made by a compounding pharmacy. There is limited research using bio-identical hormones, but they have been used by health care practitioners with great success.

Antidepressants

As the use of HRT becomes more dangerous, antidepressants are used with more frequency for women who suffer form insomnia and depression. In some cases antidepressants have helped with hot flashes. The main class of antidepressants used is selective serotonin reuptake inhibitors (Prozac and Aropax are examples). These medications have several side effects such as fatigues, rebound anxiety and sexual dysfunction.

Lifestyle and Dietary Modifications

With the increased risk for heart disease, a healthy diet is more than important, it’s essential. Focus on a high fiber, whole foods diet with modest amounts of fat and carbohydrates and adequate protein.

Refined sugars should be reduced, as rapid fluctuations in blood sugar may cause hot flashes.

Soy foods have been shown to reduce menopausal symptoms. Cultures that include soy foods in the diet have less menopausal complaints than cultures that do not. Soy foods are tofu, soy milk, tempeh, and roasted soy nuts. Only fermented soy foods should be consumed, unfermented soy foods contain enzyme inhibitors and phytates that interfere with the absorption of certain minerals. Soy products can also interfere with Thyroid hormone activity, and interact with certain thyroid medications.

Other foods to include are flax seeds, which can be ground into a meal and added to food. Flax not only contains essential fatty acids, but also lignans that have a phytoestrogen effect.

Avoiding hot and spicy foods, which frequently can trigger hot flashes.

Avoidance of coffee and caffeine containing products, not only to prevent hot flashes but unfiltered coffee products have been sown to contribute to cardiovascular disease.

Quitting smoking can reduce hot flashes, and improve overall bone density in postmenopausal women.

Prevention of the cardiovascular risk associated with menopause by aerobic exercise and healthy eating.

Weight bearing exercise is shown to improve bone mineral density

Reduce or limiting alcohol intake; alcohol not only contributes to hot flashes, but also to heart disease.

Keeping the ambient temperature of a room constant and somewhat cool can reduce hot flashes.

Nutritional Factors Shown to be Beneficial

Soy isoflavones

The most abundant soy isoflavones are genistein and daidzein. The isoflavones in soy products are converted by the bacteria in the large intestine to compounds that have weak estrogenic activity, therefore they are considered phytoestrogens.

Phytoestrogens are thought to act in the human body by bonding weakly with an estrogen receptor, therefore causing a smaller level of activity. Soy isoflavones act on tissue in the uterus, ovaries, breast, and brain. Some health care practitioners advise against the use of soy products in certain kinds of cancers, especially breast cancers. Current research is not clear.
Dose: 50 and 15 mg per day of soy isoflavones

Black Cohosh (Cimicifuga racemosa)

The best-studied herb is black cohosh (Cimicifuga racemosa). A standardized extract of black cohosh manufactured in Germany is a popular substitute for HRT.

Black cohosh has been used to treat women’s health conditions before it was known that it also contain isoflavone compounds. It has an estrogen-like effect due to these compounds.
Dose of black cohosh: (300–2,000 mg per day), Black cohosh should not be used by pregnant women. There are no known drug interactions.

Hesperidin/Vitamin C

The combination of vitamin C with the bioflavonoid hesperidin has been shown to reduce the amount of hot flashes during menopause.
Does: 1000 mg Vitamin C with 1000 mg hersperidin methyl chalone

Vitamin E

This is another supplement with demonstrated effectiveness in reducing the symptoms of menopause. Studies in the 1940s demonstrated vitamin E’s effectiveness in reducing hot flashes associated with menopause Vitamin E also helps relieve vaginal dryness. A fat-soluble antioxidant, vitamin E also helps to lower cardiovascular disease risk.
Dose of vitamin E 400-800 IU day

Omega 3 Fatty acids

Fish oils that contain high amounts of the omega 3 oils EPA and DHA have been shown to reduce blood lipids and the rate of heart disease in post menopausal women, whether or not the women have supplemented with any pharmaceutical or natural hormone replacement therapy. Consumption of fish oils have been shown to reduce the risk of endometrial and breast cancer Dose ranges from 3-5 grams a day.

St. Johns’ wort (Hypericum perforatum)

St John’s wort has been used for improving the moods associated with menopausal syndrome, and is a potent therapy for stopping hot flashes as well. St John’s wort should not be used for those taking selective serotonin reuptake inhibitor antidepressants.
Does: 500-1000 mg twice or three times a day

5-Hydroxytryptophan (5-HTP)

5-HTP is a metabolite of the amino acid tryptophan and increases serotonin levels naturally and is more preferred than Prozac.
Dose: 100-300 mg a day

Acupuncture

Acupuncture has been studied to reduce hot flashes and improve quality of life in postmenopausal women.