The term Menopause means to stop menstruation. A woman is deemed in ‘menopause’ when there has been no menstrual period for 12 months.
The average age is estimated to be between 50 and 52. Peri-menopause, the period of time before menopause, occurs on average at 47 years and lasts 4 – 5 years.
During perimenopause the number of eggs reaches very low levels from 1-2 million at birth to a few thousand. The menstrual cycle shortens. The levels of FSH (follicle stimulating hormone) in the body increase. Ovarian production of estradiol, progesterone and testosterone decrease with the onset of true menopause.
Signs and symptoms of decreased hormone levels in peri-menopausal women are varied and unpredictable, these include:
- Menstrual irregularities: This is normal and natural. A woman can bleed less or more often and can switch back and forth, go shorter or longer, heavier or lighter. Treatment comes into play when there is too much blood loss.
- Hot flushes: 75% of women experience hot flushes and 15% are severely affected. The occurrence is highest in the 1st 2 years post menopause. In some women it lasts for 5 – 10 years. Frequency varies from every hour to several episodes a year. The clearest explanation is they appear to be the body’s response to a sudden transient downward re- setting of the body’s thermostat, located in the hypothalamus. The primary problem for many women with hot flashes is sleep disturbance.
- Vaginal dryness and thinning: Vaginal dryness, vaginal thinning usually do not become troublesome until several years after menopause. Estrogen is responsible for the thickened elastic, lubricated tissue of the vagina and vulva. When estrogen declines the vulva loses its collagen, fat and water retaining ability. The vagina shortens and narrows; it becomes flattened thin and dry in 2 out of 3 women.
- Skin changes: Lowered estrogen may result in less collagen and elasticity, dry eyes, dryness, wrinkling, hair thinning, acne (due to increased free testosterone); receding gums
- Decreased Libido: At menopause the ovaries continue to secrete androgens – mainly testosterone and androstenedione. A woman’s total estrogen production decreases by 70 – 80 % while androgen production decreases by 50%. Total testosterone is reduced. The ovaries, however, do continue to produce a significant amount of estrogen and androgens. Most but not all sexual problems in postmenopausal women are related to estrogen loss to the genitals. At least 86% of postmenopausal women experience some form of decreased libido. Testosterone plays an important role.
- Mood swings; depression; anxiety: Mostly correlated with peri-menopause; depression was higher for women who remained in perimenopause for at least 27 months – it is considered transient and as women move through post menopause, their rates of depression decline.
- Changes in memory and cognition: Short-term memory impairment is a common cognitive change in women with natural menopause. Difficulty concentrating, memory decline and lack of mental clarity are worsened by difficulty sleeping and sleep interruptions.
- Sleep disturbances: Insomnia can be due to anxiety, sleep apnea, medications, and bad habits. Neurotransmitter and hormonal changes in the brain during peri and menopause may also cause sleep issues.
- Hair loss on the head, hair growth on the face, acne: Women can have individual sensitivities to androgens. Some women only react to very high levels, while other are sensitive to normal levels. Acne is always triggered by androgens, excessive hair growth occurs in areas where hair follicles are the most androgen sensitive –face, chin, skin under jaw, upper sideburn area and cheeks. Thinning of the hair is the most common on the top of the crown. Saw Palmetto, & nettle root or seed (DHT inhibitors) works well for women experiencing an over expression of androgens.
- Palpitations: These are usually hot flush related.
- Headaches: If a woman has a history of menstrual migraine, these can get worse in peri-menopause.
- Urinary tract infections: Less estrogen is delivered to urogenital tissue which can lead to less elasticity, less lubrication, itching/ burning, more leakage and bladder infections. There is also more narrowing of the vagina and penetration can be painful.
- Joint pains: Frozen shoulder more common in menopause.
- Weight gain: The lowering of estrogen can lead to insulin resistance which can result in weight gain. Also, as we get older, the metabolism slows and there tends to be a loss of muscle mass, which again leads to weight gain.
Conventional Hormone Replacement Therapy benefits:
- Reduces symptoms of menopause
- Reduces risk of osteoporosis, if at risk for excessive bone loss
Hormone Replacement Therapy risks:
- Slight increased risk of breast cancer
- Increased risk of gallbladder disease, dementia
- Increased incidence of heart attack, stroke, blood clots in first 1-2 years of use
- Increased risk of urinary frequency and incontinence in the first year of use
- Balanced diet: Eat at least 3 meals per day. Eat protein with each meal. Consume a low sugar and refined carbohydrate diet. Eat 5+ servings of different coloured fruit and vegetables per day. Include healthy fats like fish, nuts, and avocados in diet. Reduce saturated and trans-fats in diet (red meat, fried foods, margarine).
- Soy: phytoestrogenic effects
- Phytoestrogens act between 100 & 1000X weaker than real estrogens. They act as agonists and antagonists by occupying receptor cites on the cell for estrogens – when estrogens are too low they help boost lower levels when they are too high they block the over-expression of estrogens.
- Reduces menopausal symptoms
- Reduces cholesterol, LDL, triglycerides
- In a diet with high phytoestrogens using soy and flax seeds – the best reductionsin menopausal symptoms were in hot flashes and vaginal dryness. A diet containing 76mg of isoflavones in 12 weeks showed a 26% drop in hot flashes in 3 weeks, a 33% drop in 4 weeks and a 45% drop in 12 weeks. The range of
- Isoflavones should be in the range of 50mg a day.
- May reduce risk of breast cancer, endometrial cancer, and osteoporosis
- In fact, 3 major studies in the last 5 years (it’s now 2015) have shown that soy isSAFE and beneficial in breast cancer patients and survivors.
Dose: 160 mg of soy isoflavones per day
*200 mg of isoflavones is approximately equivalent to 0.3 mg of conjugated equine estrogens (half-strength Premarin)
- Other phytoestrogenic foods: oats, barley , flaxseeds, alfalfa, almonds, lentils
Soak soybeans 12-24 hours; boil 10 minutes; sprinkle with salt or soy sauce; single layer on flat baking sheet in 170 Celsius oven for 20-30 minutes, checking regularly until golden in colour.
Mix together: 2 crushed garlic cloves, 1 tsp. grated ginger, 3 tablespoons soy sauce, 3 tsp. honey or maple syrup, 1 tablespoon toasted sesame oil. Pour over 1 block of cubed, firm tofu. Allow to marinate 1-12 hours. Great in stir fries or in salads!
Exercise: 30 minutes a day may decrease symptoms by 25%. Vary activities: aerobic, strength, flexibility.
- Quit smoking
- Decrease or eliminate alcohol and caffeine
- Stress management
- Get quality, consistent sleep
- Body, mind, spirit connections
- Vitamin B6- depression, insomnia, irritability; Is an important B-Vitamin involved with the metabolism of proteins, neurotransmitters and hormones, an insufficiency of B-6 may cause insomnia and irritability; aim for 50-200mg a day.
- Vitamin E- topical; vaginal dryness
- Evening Primrose oil – effective for relieving breast pain, but not hot flushes.
- Gamma oryzanol (ferulic acid) – hot flashes, helps decrease cholesterol levels; Gamma Oryzanol – 100mg. taken 3x a day. Gamma Oryzanol is derived from rice bran oil the compound Ferulic Acid found in gamma oryzanol has been found useful in relieving menopausal hot flashes. 67% of the women taking it had a 50% or greater improvement in their menopausal symptoms. In a later study 85% of the women found it effective. However, in practice, Tori Hudson has not found it very effective for hot flushes.
- Fish oils: for hot flushes and depression; one capsule, 3 times daily (350mg EPA/ 50 mg DHA); in a study of 120 women taking this for 8 weeks, hot flush frequency reduced by 55%
- Black Cohosh: Can help to decrease hot flashes, night sweats, insomnia, mood swings, and vaginal dryness. Daily use of the standardized extract is 2 – 40mg. caps 2X a day. The results should be evident within 2 to 4 weeks. – Clinical studies show it helps with hot flashes, depression and vaginal atrophy. Black Cohosh appears to suppress the secretion of pituitary hormone LH but does not affect prolactin & FSH. Used in Germany since the 1940’s a big German study with 629 women – clear improvement was seen in 80% of the women after 6 to 8 weeks. Complete disappearance of symptoms occurred in 50%. In another study and estrogen like stimulation of the vaginal mucosa happened in 4 weeks. Black Cohosh should not be considered a substitute for the prevention of osteoporosis and heart disease. It is considered safe for women with a history of hormone dependent cancers and a safe and appropriate treatment for hot flashes, night sweats, insomnia, mood swings and vaginal dryness. Side effects: stomach upset, headaches, heaviness in legs. Safe for women with a history of cancer, endometriosis, liver/ gallbladder disease, or fibroids.
- Dong Quai: Can help to decrease hot flashes. Best when used in combination with other herbs. Contraindications: can increase heavy or frequent menses.
- Chasteberry (Vitex agnus castus): Used to regulate the menstrual cycle. Needs to be taken for at least 12 weeks. Chaste Berry (Vitex) – Used more before menopause than after. Chasteberry is the most important herb to normalize and regulate the menstrual cycle. It’s effect is on the hypothalamus – hypophysis axis one of the mechanisms is it increases secretion of LH and also has an effect that favors progesterone. It can benefit irregular bleeding. Contraindications: Should not be taken in conjunction with HRT, progesterone, or birth control pills.
- Red clover: Used for hot flashes. Contraindications: Should not be used in women with a history of breast or uterine cancer.
- Gingko biloba: Improves circulation, mental clarity, concentration, and memory. Works best when taken at least 12 weeks. Caution when on blood thinning medications.
- Panax ginseng: Can help decrease fatigue and stress. Contraindications: Should not be used with excessive caffeine- stimulant.
- St. John’s Wort: Helpful for depression and anxiety. Contraindications: Should not be taken for severe depression. Side effects: Sensitivity to the sun if taken in large amounts.
- Rhodiola: Good for memory, depression, low energy.
- Maca: (good for flushes, low libido and fatigue), pine bark, kava, kudzu, Hops, Siberic Rhubarb
Tori Hudson, ND has found the following herbal combos very helpful:
- Depression + hot flushes: Black cohosh OR Maca and St. John’s wort
- Hot flushes, mood changes, and cyclic PMT symptoms: St. John’s wort, Vitex agnus castus, B6 and Calcium
- Fatigue, low libido, hot flushes, irregular menses, poor sleep, vaginal dryness: Maca, valerian, 5HTP, vaginal estrogen
- Hot flashes in 60 year old breast cancer survivor: Black cohosh and pine bark extract or gamma oryzanol (Maca and siberic rhubarb are iffy safety-wise.)
- Depression and low libido: St. John’s wort, Maca
- Decreased sexual desire in perimenopausal woman: Maca and maybe DHEA if salivary test show she is low
Heart disease is the leading cause of death in women. Screening for heart disease includes blood pressure checks at least once every 2 years, and cholesterol testing beginning at age 45 and repeated every 5 years.
Cardiovascular disease prevention
- Stop smoking- it’s the greatest risk factor in heart disease
- Achieve healthy body weight
- Small-moderate amount of wine
- Exercise 30 minutes a day- sedentary women are 3 times more likely to die of heartattacks than active women
- High fibre, low fat diet
- Fish oils or fish in diet
- Antioxidants and other vitamins
- Herbs and other supplements
- Consult health care provider to develop plan
Osteoporosis risk factors
- Personal history of fracture as and adult or and adult fracture in an immediate family member
- Current cigarette smoking
- Low body weight (less than 135 pounds)
- Certain drugs (corticosteroids, lithium, check with your GP)
- Weight bearing exercise
- Foods for Bone Health – Peak bone mass occurs at the age of 35 – 40 in caucasionwomen. One of the best dietary preventative habits is to eat a lot of dark leafy greens – kale, collards, romaine lettuce, spinach, swiss chard are a rich source of vitamins, minerals (such as magnesium), vit K and boron both of which are essential for bone formation and development. Low fat dairy especially yogurt and kefir, baked beans, soy, sesame, salmon, sardines, tofu and amaranth.
- Calcium- 1200 mg elemental calcium per day; Magnesium- 750 mg per day
- Vitamin D- 200-400 IU per day
- Avoid excess caffeine, alcohol, soft drinks- these decrease calcium absorption
- Exercise + calcium+ vitamin D can reduce fractures by 30%