Menopause didn’t really come into vogue as a topic of concern for the medical profession until the 1960s. In 1966 a New York gynecologist, Dr. Robert Wilson, wrote a best seller called Feminine Forever, extolling the virtues of estrogen replacement to save women from the “tragedy of menopause which often destroys her character as well as her health.” His book sold over 100,000 copies in the first year. Wilson energetically promoted menopause as a condition of “living decay”.
According to Dr. Wilson, estrogen replacement was a kind of long sought-after youth pill that would save poor, fading women from the horrors of age. He popularized the erroneous belief that menopause is a deficiency disease. Women’s magazines eagerly seized upon his ideas and extensively promoted his concepts. This pleased Wilson no end, since he had earlier set up The Wilson Foundation for the sole purpose of promoting the use of estrogen drugs.
The pharmaceutical industry generously contributed over US$1.3 million to his Foundation. Each year he received funds from such companies as Searle, Wyeth-Ayerst Laboratories and Upjohn which made hormone products that Wilson claimed were effective in treating and preventing menopause. Pharmaceutical companies jumped on the bandwagon with aggressive promotions and advertising campaigns. His message hit a receptive chord: mid-life women need hormone drugs to be rescued from the inevitable horrors and decrepitude of this terrible deficiency disease called menopause. Wilson pioneered the use of unopposed estrogen.
Having pointed this out, it is true that many women find great benefit from the use of bioidentical hormones at this time in life. A clear distinction must be kept in mind, namely that non-human or artificial estrogens and progestins are more dangerous and less beneficial than using the natural forms. The use of natural estrogens and progesterone is important in some women at menopause, when troubling symptoms continue. The continued use of the appropriate natural hormone(s) for years can be without side effects and provide ongoing significant health benefits.
You can develop a clearer understanding of the nature of menopause and the interplay of female hormones by reading an informative book such as Natural Hormone Balance by Uzzi Reiss, MD, or What Your Doctor May Not Tell You About Menopause by John Lee, MD.
Surgical menopause involves the removal of the uterus and/or ovaries. A hysterectomy usually indicates that part or all of the uterus was removed. An oophorectomy means that one or both of the ovaries have been removed. If the uterus is removed but one or more ovaries remain, then technically a person is in menopause since menopause means the end of having periods. The symptoms usually associated with menopause are due to declining hormone production from the ovaries and may occur many years after surgical menopause, usually around age 50.
One study has suggested that dong quai, sometimes recommended in menopause, is no better than a placebo at relieving the symptoms of menopause.
Signs, symptoms & indicators of Menopausal Status / Issues
Reduced well-being during menopause
Conditions that suggest Menopausal Status / Issues
Metabolic Syndrome (Syndrome X)
A recent Australian study tracked the metabolic health of 265 women aged 46-57 for five years as many of them progressed through menopause. The study found that a surprisingly high percentage of these women – nearly 1 out of 6 – developed impaired fasting glucose levels during this time.
During the menopause transition, more fat often starts to accumulate around the stomach and insulin levels begin to inch upwards. This subtle change can trigger a drop in levels of sex-hormone-binding-globulin (SHBG), the substance that attaches to sex hormones in the bloodstream and makes them inert. With reduced SHBG levels, greater amounts of bioactive “male” sex hormones – androgens such as testosterone and DHEA – begin to circulate inside a woman’s body.
Over time, this oversupply of active androgens can make women more male-like in appearance, fuel more obesity in the stomach region, and disrupt glycemic control. Left unchecked, these imbalances often become self-perpetuating, thus stimulating further weight gain and metabolic dysfunction that eventually increases the risk of syndrome X, diabetes, cardiovascular disease, and certain cancers. [Obes Relat Metab Disord. 2001;25(5): pp.646-51]
Being menopausal
Counter Indicators
Being premenopausal or being postmenopausal or being perimenopausal
Menopausal Status / Issues suggests the following may be present
Metabolic Syndrome (Syndrome X)
A recent Australian study tracked the metabolic health of 265 women aged 46-57 for five years as many of them progressed through menopause. The study found that a surprisingly high percentage of these women – nearly 1 out of 6 – developed impaired fasting glucose levels during this time.
During the menopause transition, more fat often starts to accumulate around the stomach and insulin levels begin to inch upwards. This subtle change can trigger a drop in levels of sex-hormone-binding-globulin (SHBG), the substance that attaches to sex hormones in the bloodstream and makes them inert. With reduced SHBG levels, greater amounts of bioactive “male” sex hormones – androgens such as testosterone and DHEA – begin to circulate inside a woman’s body.
Over time, this oversupply of active androgens can make women more male-like in appearance, fuel more obesity in the stomach region, and disrupt glycemic control. Left unchecked, these imbalances often become self-perpetuating, thus stimulating further weight gain and metabolic dysfunction that eventually increases the risk of syndrome X, diabetes, cardiovascular disease, and certain cancers. [Obes Relat Metab Disord. 2001;25(5): pp.646-51]
Recommendations for Menopausal Status / Issues
Black Cohosh (Cimicifuga racimosa)
A review of 29 studies of therapies for hot flashes and menopausal symptoms concluded that black cohosh and foods that contain phytoestrogens show promise for the treatment of menopausal symptoms; clinical trials do not support the use of dong quai, evening primrose oil, red clover, or vitamin E. [Ann Intern Med 2002;137(10): pp.805-13]
Vitex
Low levels of progesterone are believed to contribute significantly to menopausal symptoms. The ability of vitex to increase the secretion of luteinizing hormone which raises progesterone levels is the likely mode of action. Physicians in Europe commonly recommend vitex for the treatment of hot flashes.
Maca (Lepidium meyenii)
Dr. Malaspina, a respected cardiologist in Lima, has been using the maca root in his practice for a decade and reports finding maca to be effective for women with menopausal symptoms, including one who had had her ovaries removed. Maca is usually taken several months before symptoms subside.
Red Clover (Trifolium pratense)
Red clover extract (80mg per day of isoflavones for a 12 month period) reduced the number of hot flashes in a double-blind, placebo-controlled trial of 30 women who had not had a period for over 12 months and were experiencing more than five hot flashes per day. [Reported at the North American Menopause Society 12th Annual Meeting, Oct 4-6, 2001, New Orleans, LA.]
However, a review of other studies did not support this finding. [Ann Intern Med 2002;137(10): pp.805-13]
Soy Isoflavones (genistein, daidzein)
Although study results are sometimes confusing on the issue of soy extracts and menopause, some studies have shown clear benefit. One such study concluded that a particular soy product “…may be a safe and efficacious therapy for relief of hot flushes in women who refuse or have contraindications for hormone replacement therapy.” [Menopause 2000;7: pp.105-111]
The North American Menopause Society suggests that soy isoflavones can also be a natural alternative to estrogen replacement therapy for relief of mild menopausal symptoms. It may help offset the drop in estrogen and regulate its fluctuations that occur at menopause. Many women have reported a reduction in their hot flashes and night sweats when they regularly consume soy foods, like tempeh or tofu.
Another study found consuming one capsule TID of a soy extract totaling 100mg of soy isoflavones per day effectively alleviated vasomotor symptoms, such as hot flashes, associated with menopause over a 4 month period compared with a placebo. Total cholesterol and low-density lipoproteins were reduced also in the soy isoflavone group compared to placebo. No difference in FSH and LH levels were observed between the placebo and the soy isoflavone group. An increase in estrogen levels was observed only in the soy isoflavone group but this did not result in an increased endometrial thickness. [Obstet Gynecol 2002;99: pp.389-94]
Four months of treatment with a soy isoflavone product reduced the number of hot flashes and other menopausal symptoms in a study of 190 postmenopausal women in Spain. [Phytomedicine 2002;9(2): pp.85-92]
A separate analysis of isoflavones, a component of soy, was also carried out. Dr. Frank Sacks, a professor of nutrition at the Harvard School of Public Health in Boston. According to Dr. Sacks, there are is no evidence that it could reduce symptoms of menopause like ‘hot flashes’ or even osteoporosis.
Progesterone
Natural progesterone can protect against facial hair and male pattern baldness that some women have after menopause. It can help with other symptoms as well, including hot flashes in some women.
Test / Monitor Hormone levels
Checking primarily for estrogens and progesterone at this time of life, with subsequent hormone balancing, can provide both immediate and long-term benefit.
Reading List
Suzanne Somers has brought bioidentical hormones onto center stage. In her book, The Sexy Years…, she describes how bioidentical hormones relieved her menopause symptoms. She also makes it clear that she intends to stay on them for the rest of her life.
Emotional Freedom Technique (EFT)
The concept behind EFT is that many physical ailments, including excess menopausal symptoms, are often caused by (1) interruptions to the free flow of the subtle energies in our bodies and/or (2) unresolved anger, guilt, fear and trauma that manifest as physical symptoms.
It is claimed that EFT reduces or even even eliminates the intensity of menopausal symptoms. EFT will not make you younger, of course, but with it you can collapse your hot flashes and night sweats, counteract weight gain, mood swings, and loss of libido and enter the next stage of your life with health and vitality.
Vitamin E
Vitamin E, at a dose of 800 IU per day, is modestly effective in reducing hot flashes, on average cutting the number by one per day. [The Lancet Oncology 2001;2: pp.199-204] A review of other studies did not support the use of vitamin E for this purpose. [Ann Intern Med 2002;137(10): pp.805-13]
Vitamin E may be worth trying because it is safe and inexpensive. Up to 3,000IU per day is considered more effective by some doctors, but will have somewhat of a blood thinning effect. Some researchers believe the unesterified forms may be more effective.
Key
| Weak or unproven link |
| Strong or generally accepted link |
| Proven definite or direct link |
| Very strongly or absolutely counter-indicative |
| May do some good |
| Likely to help |
| Highly recommended |
Glossary
Menopause
The cessation of menstruation (usually not official until 12 months have passed without periods), occurring at the average age of 52. As commonly used, the word denotes the time of a woman's life, usually between the ages of 45 and 54, when periods cease and any symptoms of low estrogen levels persist, including hot flashes, insomnia, anxiety, mood swings, loss of libido and vaginal dryness. When these early menopausal symptoms subside, a woman becomes postmenopausal.
Estrogen
One of the female sex hormones produced by the ovaries.
Hormones
Chemical substances secreted by a variety of body organs that are carried by the bloodstream and usually influence cells some distance from the source of production. Hormones signal certain enzymes to perform their functions and, in this way, regulate such body functions as blood sugar levels, insulin levels, the menstrual cycle, and growth. These can be prescription, over-the-counter, synthetic or natural agents. Examples include adrenal hormones such as corticosteroids and aldosterone; glucagon, growth hormone, insulin, testosterone, estrogens, progestins, progesterone, DHEA, melatonin, and thyroid hormones such as thyroxine and calcitonin.
Hysterectomy
Surgical removal of the uterus, by way of either an abdominal or vaginal incision. Removal might include removal of the cervix (total hysterectomy) or not (subtotal / partial hysterectomy). A radical hysterectomy involves surgical removal of the uterus, upper vagina, tissues adjacent to the uterus and possibly the ovaries; usually undertaken for carcinoma of the uterus. A hysterectomy with oophorectomy involves the removal of the uterus and one ovary (unilateral oophorectomy) or both ovaries (bilateral oophorectomy).
Placebo
A pharmacologically inactive substance. Often used to compare clinical responses against the effects of pharmacologically active substances in experiments.
Metabolism
The chemical processes of living cells in which energy is produced in order to replace and repair tissues and maintain a healthy body. Responsible for the production of energy, biosynthesis of important substances, and degradation of various compounds.
Glucose
A sugar that is the simplest form of carbohydrate. It is commonly referred to as blood sugar. The body breaks down carbohydrates in foods into glucose, which serves as the primary fuel for the muscles and the brain.
Stomach
A hollow, muscular, J-shaped pouch located in the upper part of the abdomen to the left of the midline. The upper end (fundus) is large and dome-shaped; the area just below the fundus is called the body of the stomach. The fundus and the body are often referred to as the cardiac portion of the stomach. The lower (pyloric) portion curves downward and to the right and includes the antrum and the pylorus. The function of the stomach is to begin digestion by physically breaking down food received from the esophagus. The tissues of the stomach wall are composed of three types of muscle fibers: circular, longitudinal and oblique. These fibers create structural elasticity and contractibility, both of which are needed for digestion. The stomach mucosa contains cells which secrete hydrochloric acid and this in turn activates the other gastric enzymes pepsin and rennin. To protect itself from being destroyed by its own enzymes, the stomach’s mucous lining must constantly regenerate itself.
Insulin
A hormone secreted by the pancreas in response to elevated blood glucose levels. Insulin stimulates the liver, muscles, and fat cells to remove glucose from the blood for use or storage.
Testosterone
The principal male sex hormone that induces and maintains the changes that take place in males at puberty. In men, the testicles continue to produce testosterone throughout life, though there is some decline with age. A naturally occurring androgenic hormone.
DHEA
Dehydroepiandrosterone (DHEA) is a steroid produced by the adrenal glands and is the most abundant one found in humans. DHEA may be transformed into testosterone, estrogen or other steroids. It is found in the body as DHEA or in the sulfated form known as DHEA-S. One form is converted into the other as needed.
Diabetes Mellitus
A disease with increased blood glucose levels due to lack or ineffectiveness of insulin. Diabetes is found in two forms; insulin-dependent diabetes (juvenile-onset) and non-insulin-dependent (adult-onset). Symptoms include increased thirst; increased urination; weight loss in spite of increased appetite; fatigue; nausea; vomiting; frequent infections including bladder, vaginal, and skin; blurred vision; impotence in men; bad breath; cessation of menses; diminished skin fullness. Other symptoms include bleeding gums; ear noise/buzzing; diarrhea; depression; confusion.
Cardiovascular
Pertaining to the heart and blood vessels.