Saturday, July 19, 2008

Menopause: Treating Symptoms Naturally

Thanks to modern medicine, more women are living longer, healthier lives and contributing to a larger percent of the overall population. Now, more women than ever are entering their menopausal years-36 million in America alone. In turn, the media and medical pro-fessions have re-sponded to this shift and flooded newspaper and magazines alike with an abudance of information about menopause and hormone replacement therapy (HRT).

Perhaps it is time we looked at men-opause in a simpler light. Menopause is, after all, a natural process women have been experiencing for thousands of years before modern medicine enabled us to alter its effects.

Medical terms often describe a woman's body in menopause as "estrogen deficient," or as having "failed production." Characterizing menopause as a pathology, medicine sees its role as one of "managing" the natural menopause process.

Research shows that physicians typically see only those women with the most severe menopausal symptoms. This gives rise to the perception that all menopausal women suffer similarly. While 75-80 percent of menopausal women experience one or more physical symptoms, only 10-35 percent are affected strongly enough to see their physician. Clearly, not all women experience menopause alike.
Going Through "The Change"

For most menopausal American women, ovulation stops between ages 45 to 55, while menstruation stops between 50 to 52. During men-opause, the ovaries cease to function, and estrogen and progesterone levels drop. Other areas of the body, such as the adrenal and pineal glands, the skin and muscles, hair follicles, and body fat are capable of making some of these hormones. Their performance is dependent on a woman's lifestyle and diet. The stronger the adrenals and the better the overall nutrition of the woman, the easier her transition into and through menopause. Chronic stress, poor nutrition, and lack of exercise can cumulatively lead to adrenal and emotional depletion, and hence more intense menopausal distress. Common symptoms at the onset of menopause may include: hot flashes, mood swings, excessive menstrual bleeding, vaginal dryness, vaginitis, insomnia, and urinary tract infections.

The female hormone estrogen acts directly on the uterus. It also affects the vagina and vulva, breasts, bones, heart, skin, and hair, as well as the emotions. The functioning and appearance of these areas of the body are significantly affected by decreasing levels of estrogen during menopause-the most serious problem being an increased risk of developing osteoporosis and heart disease. Given these real changes and the many conditions that can result from a drop in estrogen levels in a woman's body, it is easy to see how estrogen replacement therapy came into being.

Should you Replace Estrogen?

Forty percent of menopausal American women are currently taking synthetic hormones, making synthetic estrogen the best-selling drug in the U.S. A look at the history of HRT reveals some of the controversial issues surrounding its use.

Prescription synthetic estrogens became available as birth control and also as estrogen replacement therapy in the 1950s. Initially, HRT was hailed as a panacea, only to discover in the mid-1970s that it contributed to an increase in uterine cancer. Thereafter, HRT fell into disfavor, as doctors and patients alike were reluctant to use it. In the late 1970's, the addition of synthetic progesterone to HRT reduced the uterine cancer threat.

Today HRT (in lower doses) is most often prescribed for women suffering from the side effects of menopause (hot flashes, insomnia, etc.) that strike during its onset and level out over time. Over half the women for whom HRT is prescribed make the decision to stop taking it within a year or so when their hormone levels have stabilized; this is probably due to HRT's common side effects: bloating, depression, headaches, and menstrual bleeding.

In HRT's favor, new studies have shown long-term HRT use (five years or more) helps reduce fractures from osteoporosis and slows the development of heart disease. Unfortunately, there is still a debate over the breast cancer risk associated with long-term estrogen use. And even with the added balance of synthetic progesterone, there is still a small increased risk of ovarian cancer development,too.

The Breast Cancer Issue

The hormone therapy question became front page news after a study published in the New England Journal of Medicine last June linked long-term HRT to increased breast cancer risk. The study, conducted by the Harvard Medical School, found that women using HRT for five years or more after the onset of menopause, were 30 to 40 percent more likely to develop breast cancer than women who did not take synthetic hormones. To confuse matters, a second study appeared soon after in the Journal of the American Medical Association (JAMA) which found no increased risk of breast cancer in women taking synthetic hormones.

The Harvard study followed 70,000 postmenopausal women nurses-most of whom took HRT or ERT (estrogen alone, is prescribed to women with hysterectomies) and about 40 percent who did not take hormones. The women in this study who took HRT longer than five years showed about a 40 percent increase in breast cancer risk. For women taking only ERT, the risk increase was slightly less.

The second study, published in JAMA, looked at 500 women who had breast cancer and 500 who did not. The comparison between these 1,000 women showed no increased breast cancer risk in women taking ERT or HRT for more than eight years.

Last October, UC Berkeley Wellness Letter summed up their opinion of these two studies...

"The number of women involved [in the JAMA study] was much smaller than in the nurses' study, and so the second study may not have been able to detect relatively small increases in breast cancer risk. More research is needed, and indeed several studies are underway."

Physicians agree, women with active breast cancer, breast cancer in remission, and family histories of breast cancer are not recommended to take HRT. Synthetic hormones taken for under five years after the onset of menopause do not currently appear to increase a woman's risk of developing breast cancer. The debate over long-term use continues, however.
Heart Disease

While women fear breast cancer the most (due to its tendency to strike at a younger age), heart disease is actually the leading cause of death of postmenopausal women. Some studies have linked decreased estrogen levels with increased heart disease, favoring the long-term use of HRT. In agreement, studies have shown HRT helps reduce the risk of heart disease-related death in postmenopausal women by 25 to 50 percent. However, there are many other factors that have made cardiovascular disease epidemic in our Western culture today for both women and men: High stress, lack of exercise, high-fat/low fiber diets, as well as family history contribute to an individual's risk. Proper nutrition and exercise are significantly effective in fighting off heart disease regardless of hormone levels.

Long-term HRT also reduces the risk of strokes and does not raise blood pressure levels. Many doctors believe women should begin HRT at menopause and continue for the rest of their lives in order to get the best protection against heart disease and osteoporosis.

Should you Replace Estrogen?


Although there is a link between decreased estrogen levels and bone loss, women's bone loss begins in their early thirties before estrogen levels begin to drop. This indicates bone loss is more complex than only a decrease of estrogen. Currently, studies are in conflict over how effective HRT is in slowing bone loss. Some claim HRT can reduce fractures by up to 50 percent, while others claim that diet and exercise are the most significant factors in determining bone density over time. (See Menopausal Exercises.")

A diet too high in protein creates a slightly acidic condition in the blood. To offset this, the body breaks down bone to buffer the blood with that calcium. A high-fat diet decreases absorption of calcium from the diet. Caffeine, alcohol, cigarettes, and chronic stress each contribute to osteoporosis. Colas contain phosphorous, which interferes with calcium metabolism. Corticosteroid, anticonvulsant, and diruetic medications also interfere with calcium absorption. Magnesium, needed for proper bones, is absent in a diet high in refined grains and low in green leafy vegetables.

For healthy bones, a life-long balanced diet high in calcium-rich foods is essential. Calcium-rich foods include the dark leafy green vegetables: chard, turnip greens, broccoli, kale, Chinese cabbage, watercress, mustard greens, and dandelion greens. Molasses, calcium-set tofu, some legumes, seeds, and nuts also contain calcium. Herbs providing calcium include: oat straw, nettles, horsetail, and chickweed. Seaweeds are particularly high in calcium and also contain magnesium.

Calcium supplementation can also be beneficial. Women should strive to get 1,000 mg. of calcium daily before menopause, and 1,500 mg. daily after menopause. These are difficult amounts to get from the diet alone without supplementation.
Hot Flashes

If hot flashes are not bothersome to you, relax and enjoy the warmth, as they are not innately harmful to the body. Some women proudly refer to them as "power surges." Proper nutrition can also help prevent and treat hot flashes. These occur from hormonal fluctuations as blood vessels constrict and dilate, producing heat sensations irregularly and unpredictably. Hormones are formed from the building blocks obtained from foods. If a nutritional element is missing, a hormone deficiency or imbalance may result.

Some 75 percent of menopausal women experience hot flashes, and not all find them bothersome. For those who do, dietary recommendations include switching to a grain-based diet, and concentrating on foods rich in calcium and vitamin E found in whole grains, cold-pressed oils, leafy vegetables, and some nuts. Nutritional supplements of calcium and vitamin E can also be helpful.

Coffee, alcohol, hot spices, and foods that heat up the body can exacerbate hot flashes. Herbs that can help you keep calm during these periods include valerian and passion flower.

Treating Symptoms Naturally

Another result of decreased estrogen production is the thinning of the vaginal mucous membranes causing the sensation of uncomfortable dryness. This thinning itself does not cause difficulties but it can be painful if the vaginal lining becomes inflamed and dry. HRT dispensed as pills, patches, or vaginal creams can be used to relieve these symptoms which many women experience for a year or so at the onset of menopause. However, you can help yourself naturally by eating foods high in vitamin E, drinking lots of liquids, and lubricating the dry vagina with cocoa butter, vegetable or fruit oils (such as coconut, sesame, almond, or apricot), and cold-pressed castor oil.

Excess water retention can cause bloating, tenderness, and depression. Diuretic medications are one possible solution. However, water retention can often be corrected naturally by avoiding salty foods and drinking more liquids. Liquids flush the system. Try to eat foods high in water content such as melons, celery, and other fruits. Drink natural diuretic herbal teas of cornsilk, dandelion leaf, and uva ursi. Drink refreshing cranberry juice as a urinary tract tonic to help combat sensitivity to tract infections.
Plant Estrogens

If you're motivated to maintaining premenopausal estrogen levels naturally, some specific foods contain compounds that have estrogenic activity. Phytoestrogens (plant-derived estrogen) are present in relatively large quantities in soybean products such as tofu, miso, tempeh, soyflour, and the soybean itself. Other foods that contain significant amounts of these phytoestrogens are oats and wheat, corn, apples, almonds, cashews, and peanuts. Japanese women, with high soy content diets, have lower rates of breast cancer, uterine cancer, coronary heart disease, and hip fractures. Studies show that natural estrogens contained in plants are protective and actually block the effects of excess estrogen stimulation of the breasts and uterus. Interestingly, the Japanese have no word for "hot flash."

Although long-term HRT may help women slow the development of osteoporosis and heart disease, women who take synthetic estrogen are at an increased risk of developing breast cancer. In this case, family and personal medical history plays a large role in making the decision. Diet and exercise are both large factors in maintaining good health regardless of HRT. What is most important, however, is keeping informed about developments in menopausal treatment (studies are still on-going), evaluating the intensity of your symptoms, being aware of your individual disease risk factors, and deciding ultimately, with the help of a physician, what's best for you and your changing body.

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