Managing menopause, naturally

Gentle alternatives to HRT

Menopause is a mid-life transition that marks the end of fertility -- a "pause," or stop, of menstruation. Although enlightened thinking reminds us that this is a life change, or metamorphosis, which should be embraced as another step in life's natural stages, some women's experience with this time has more to do with pain, discomfort, and maddening symptoms than with a passive acceptance of whatever Mother Nature throws our way.

Anthropologist Margaret Mead called the time during and after menopause: PMZ, which was short for "post menopausal zeal!" Certainly, this phase of life might as well be more enjoyable, especially considering that life expectancy has lengthened while the average age of menopause remains around age 50. That means the modern woman can anticipate living nearly half her life after menopause.

However, as much as a woman might wish she felt full of "zeal," enthusiasm is often not the first attitude that comes into view. As if experiencing hot flashes isn't bad enough, many women complain of weight gain, dry skin, vaginal dryness, loss of muscle tone, depression, tiredness, and forgetfulness -- during and after menopause. No one knows every precise mechanism which causes each of these symptoms, except that they're related to erratic hormonal activity as the body's production of hormones -- namely estrogen and progesterone -- declines.

Hormone replacement therapy: No magic bullet

Since the 1960s, physicians have prescribed estrogen supplements to reduce hot flashes and other menopausal problems. However, as with most drugs, hormonal therapy is not without risk (see "Why women are choosing alternatives," p. 62). There is, in fact, an increased chance of developing estrogen-related cancers. Just yesterday, I was talking to a woman who has uterine cancer. Her doctors believe that it was caused by the estrogen she's been taking to reduce hot flashes, even though she also took progesterone to help counter estrogen's carcinogenic action. She is otherwise amazingly healthy with no family history of cancer. She represents a small statistic, a fact that offered no relief to her.

Natural alternatives

No wonder women, as well as many of their doctors, are searching for alternatives. According to scientific research and observations, many women get as much relief from vitamins and herbs as they do from hormonal drugs. While such alternatives may not be for everyone, such as those with surgical menopause caused by removal of the ovaries (who need hormone therapy), much published research, and practitioner experience, has demonstrated that herbs provide relief for many women.

Plants which spell relief

Sometimes referred to as phyto- or "plant" estrogens, they all help reduce menopausal problems, including the two biggest complaints: hot flashes and vaginal dryness. If you check out natural menopause formulas, you'll likely discover at least one of these listed among the ingredients:

* black cohosh (Cimicifuga racemosa)

* red clover (Trifolium pratense)

* soy

* Vitex agnus-castus (chasteberry)

* Siberian ginseng (Eleutherococcus senticosus)

* fenugreek (Trigonella foenumgraecum)

* dong quai (Angelica sinensis)

* licorice root (Glycyrrhiza glabra)

Another estrogenic herb that also helps improve dry skin is flaxseed, which can be used as an oil, ground in foods, or taken as a supplement. Evening primrose oil (EPO) is also helpful.

One good herb deserves another

Herbs such as these work differently than drugs. From everything we know, they are much safer because they don't flood the system with an external source of estrogen. For example, one way an herb can Work is to make the body more sensitive to the dwindling supply of estrogen and to better utilize what is available. So far, vitex is known to also enhance progesterone. Black cohosh preparations, which have been sold in Europe to reduce hot flashes for years, are now readily available in North America. Researchers at the University of Gottingen, in Germany, found at least three synergistic compounds in it that relieve hot flashes. Red clover is another menopause remedy that is growing in popularity.

Plant "estrogens" are unique in that they bind to estrogen-receptor binding sites in tissue (breast, ovarian, etc.), therefore preventing too much true estrogen from binding to tissue, and helping to reduce excess levels of blood estrogen.

Concerning vitamin E, research suggests taking at least 400-800 IU a day (along with herbs) since it seems to enhance their activity. This isn't a new idea -- back in 1949, vitamin E was recommended by prominent British menopause researcher, Hugh McLaren, M.D. A man ahead of his time, ironically, he predicted that it would become the preferred menopause therapy since he suspected that estrogen would prove to be carcinogenic! He noted that vitamin E improves the strength and flexibility of the vaginal wall and helps any abrasions that occur there to heal quickly.

Let food be your medicine

Hippocrates was right when he said, "Let food be your medicine." For good menopausal health, start with soy products, which are high in estrogen-like activity. Genistein, one of soy's most active isoflavones, is found in many menopause supplements. The large amount of tofu, soy milk, and tempeh in the Japanese diet may be one reason why so few Japanese women report menopausal symptoms. In one study, post-menopausal women ate foods said to increase estrogen: soy, red clover sprouts, and flaxseeds. All of their estrogen levels rose until they discontinued the diet. Then they fell back down.

You can also add ground fenugreek seeds -- commonly used in curries -- to your food. Using alfalfa sprouts to relieve hot flashes is a successful folk remedy from New Mexico. And, the culinary herb, sage, that you use in the kitchen is often enough to put a damper on hot flashes. Keep some preprepared sage tea in the fridge to sip during a hot flash emergency. If you find sage's pungent and astringent taste too strong, mix it with some cooling mint, lemon balm, or lemon juice.

Doctors recommend estrogen supplements not only to counter menopausal symptoms, but also because estrogen increases your bones ability to absorb calcium. This reduces the risk of eventually developing osteoporosis. It's interesting to note that in addition to few reports of menopausal symptoms, Japanese women also have a low incidence of hip fractures, suggesting that their high phytoestrogen diet protects their bones, too.

Another way to keep your bones strong is to take mineral supplements along with the herbs. A New Zealand study found that post menopausal women taking 1000 mg of calcium a day had as much as one-half less bone loss. Other supplements that are critical include magnesium and vitamin D, since they help you assimilate the calcium. Also, go easy on how much protein you eat, since large amounts can block calcium absorption. That's thought to be why vegetarian women have less bone loss.

As far as prevention goes, exercise and a low-fat and low-protein, high-fiber diet may be as important as estrogen to avoid heart, bone, and menopausal problems. Research shows that bone loss may be slowed with half-hour sessions of weight-bearing exercises three times a week -- or morel In a Swedish study, a group of menopausal women who weren't taking hormones, but did exercise at least three hours a week, had no hot flashes at all. At first, researchers thought that the exercise had to be heavy impact sports, such as running, but it's now known that any exercise helps. You can walk, ride a bike, or climb a mountain. If necessary, simply work out in a chair lifting a book, or weights, with your arms and legs.

Be patient using natural hormone therapy. Your symptoms may clear up in a few weeks, but it can take six weeks, and occasionally even longer, before you notice any difference. Then you'll be amazed at the difference such a simple therapy can make. The results are worth waiting for!

Did you know ...?

What most people mean when they say "menopause" is what is technically called: peri-menopause, a process that begins several years before the last menstrual period, when a drop in the normal production of estrogen begins. Peri-menopause officially "ends" about I year after the last menstrual period, which is when menopause -- the complete ending of menstrual cycles -- including both ovulation and menstrual periods -- begins.

Why are women choosing alternatives to ERT/HRT?

Women are showing great interest in natural options, as opposed to hormone replacement therapy, which predisposes them to:

* increased incidence of breast cancer

* increased incidence of ovarian cancer

* increased risk of stroke and heart attack

* increased incidence of uterine fibroids

* irregular bleeding

* PMS-like symptoms

* increased incidence of migraine headaches

* effects such as: facial hair, oily skin, and voice-deepening

In addition, several studies have shown that more women -- than at any previous time -- are receiving less thorough evaluations for complaints, less explanations in response to questions, and Fewer interventions from their healthcare practitioners. Supplementation provides an option.

REFERENCE

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Lieberman, S. "A review of the effectiveness of Cimicifuga racemosa for the symptoms of menopause," Journal of Women's Health 7(5):525-9, 1998.,

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Kathi Keville is director of the American Herb Association and author of 11 books, including the comprehensive Women's Herbs, Women's Health, with Christopher Hobbs (Interweave, 1998), and most recently, Aromatherapy for Dummies (IDG Books, 1999).

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