Natural Approaches to Menopause

"The most creative force in the world
is a menopausal woman with zest"
-Margaret Mead

What is Menopause?

Menopause is a process of change and transition as a woman's body sheds it's child-bearing potential and adjusts to lower levels of hormones. Menopause usually starts around the late 40's, when periods start to get more irregular and finally stop altogether as a result of decreasing ovarian function. The average age at which periods stop is around 50, but it can occur earlier, particularly in black and non-european women.

Menopause can be experienced naturally or surgically induced through the removal of the uterus with or without the ovaries being left. Earlier menopause can be induced by tubal ligation, chemotherapy or radiation therapy.

The average length of a woman's monthly cycle gradually shortens from about 28 days at age 20 to just over 26 days at age 40. The ovaries then begin to lose their ability to produce mature eggs and estrogen and progesterone. Therefore, there is a sharp drop in fertility for women in this age group. In the late 40s cycles become increasingly shorter or longer.

Eventually at menopause, the ovaries stop producing eggs altogether, and the levels of estrogen and progesterone go down. Bursts of activity from the hypothalamus and pituitary attempt to restimulate the ovaries into maintaining estrogen levels at this time. The pituitary gland has a role in controlling metabolism and body temperature, hence the 'hot' in the hot flash.

Long before the ovaries slow down, the body develops other sources of estrogen. The adrenal glands are thought to be able to adequately provide progesterone (which it is converted into estrogen by the body as needed) and estrogen after the ovaries slow down, and the fatty tissues of the body are also a source of estrogen . The ovaries themselves continue to secrete small amount of estrogen for years after the periods stop.

Enhancing the function of these organs and having a good look at diet and digestive function will benefit tremendously.

Signs and Symptoms of Menopause

These are varied, and may include:

• hot flashes
• night sweats
• vaginal dryness
• dry skin
• cramps
• varicose veins
• migraines (which may begin at this time)
• heavy menstrual bleeds
• irregular bleeding
• aches and pains in the joints
• anxiety
• depression, self-esteem issues

Causes of Menopausal problems

1. Reduction of the production of estrogen and progesterone by the ovaries, and overstimulation of the pituitary (resulting in hot flashes)

2. Adrenal exhaustion: the adrenal glands would normally compensate for the reduced function of the ovaries, but are exhausted in many women, due to a lifetime of stress and sub-optimal nutrition.

3. Thyroid- important ties exist between the adrenal glands and thyroid function, immune responses and thyroid function, as well as thyroid function and progesterone receptor levels. Addressing the adrenals often rebalances the thyroid.

4. Toxicity: the body may be toxic to start with (poor liver function, candidiasis), and has lost a natural outlet in the form of a monthly period.

5. Societal expectations and unrewarding roles

The decision of whether or not to go on hormones during menopause can be a confusing and difficult one. Increasing numbers of women are not satisfied with, and are questioning conventional treatments offered. Medical Doctors disagree about whether all menopausal women should be on hormones and which hormones, and whether hormones should be reserved for severe symptoms or not. It is important to be as informed as you can to make a responsible decision. Consult your Naturopathic or Herbalist for preventitive measures and effective alternative treatments.

Bone Loss

There is no agreement among doctors as to how long hormones should be continued to prevent bone loss, although many doctors recommend taking Hormone Replacement Therapy (HRT) indefinitely.

When estrogen therapy is begun, it is unclear how long it must be continued to maintain benefit. Its discontinuation leads to a phase of accelerated bone loss, like that which follows natural menopause, and protection against fractures may be lost 5-10 years after discontinuing HRT.

The key to the prevention and treatment of osteoporosis lies in a balanced body chemistry with a balance of minerals in the blood. Be sure to take a calcium supplement which has good bioavailability in the body. Dairy and elemental forms of calcium can be the cause of health hazards, and should be avoided as a source of calcium. Ideally, calcium should be taken in conjunction with other essential bone building minerals and vitamins, and it is best to consult a professional for a individualized prescription. Regular, weight-bearing exercise is considered one of the most important factors in bone health and strength.

An interesting study has shown that the Bantu women of Africa have very little osteoporosis after menopause even though their daily calcium intake is only about 350 mg. They also have higher postmenopausal estrogen levels. Their adrenal glands are probably far less exhausted than those of their North American sisters.

Osteoporosis is completely preventable without drugs, expensive supplements and expensive treatments.

Heart Disease

Next to osteoporosis, the biggest health threat the concerns menopausal women is heart disease. There is a rise in cholesterol in the blood at menopause, mostly due to a rise in low-density lipoproteins cholesterol (LDLs-the 'bad' fats) which is especially linked to heart disease.
Japanese researchers have also found higher levels of triglycerides, another fat that is implicated in heart disease, in the blood of post menopausal women. Taking prescribed estrogens decreases total cholesterol, increasing the good chol (HDL) and decreasing the bad chol (LDL). They also increase the levels of one of the 'bad fats' in the blood-triglycerides. When estrogen skin patches are used, HDL levels do not increase. Some forms of prescribed progesterone cancel out the beneficial effects of estrogen.

Not all doctors agree that estrogen is the best solution for the prevention of heart disease. A recent article in the medical journal Lancet (Apr 6/91) states a more logical treatment would be a direct change in the lipids (by for example changing the diet). Researchers say that good nutrition can help to prevent heart disease after menopause.

Herbs To Consider

Plant hormones are called phytosterols. Phytosterols provide hormonal building blocks, which are in a form the body can easily convert but which are not otherwise active in the body. The body converts precisely the amount needed and no more. Using plants rich in phytosterols is much different from taking chemical hormones; plant estrogens are only 1/400 as strong as the commonly prescribed estrogen.
They are safe and gentle, and to date, no side-effects have ever been associated with the use of phytosterol-rich herbs. However, there is a strong correlation between consumption of phytosterol-rich foods (such as soybeans and yams) and decrease in breast cancer rates.

I suggest you try one of the following herbs at a time to find the ones that work best for you. This information can by no means substitute for professional individual treatment by a qualified alternative practitioner, and I strongly encourage you to seek professional guidence to oversee your progress. Even using smaller amounts of these herbs during the early menopausal years will help nourish your ovaries, adrenals and pituitary, creating a smoother passage through menopause.

Cimicifuga racemosa (Black Cohosh)
This has been clinically proven to be as effective as Estrogen Replacement Therapy (ERT) in relieving menopausal problems such as hot flashes, sleep disturbances, and irritability. Regular use decreases vaginal dryness, atrophy, and increases lubrication. Black Cohosh has no specific effect on libido.

American and European herbalists say regular use of black cohosh tonifies and strengthens pelvic muscles, preventing and correcting uterine and bladder prolapses. Black cohosh is a cardiotonic, causing dilation of the blood vessels, thinning the blood thereby lowering blood pressure and improving circulation, Antispasmodic actions and aspirin-like salicylates that dilate the blood vessels as well as constituents that slightly depress the central nervous system make it great for relieving pain. It is used to balance the nerves, and is used for anxiety or hysteria.

Black cohosh is specifically estrogenic, and therefore unopposed with progesterone, risks endometrial buildup if used for long periods of time. Therefore, use blackcohosh in a well-rounded formulae with other herbs. Black cohosh should not be used if you suspect you may be pregnant, or have menstrual flooding.

Dong quai (Angelica senesis)
Dong quai has no direct estrogenic effect on the body, so can be used safely for women with whom estrogen is a problem. This root is famed in Chinese medicine for its affinity for the female constitution. It is well known in China as the foremost female tonic, and is referred to as 'the female ginseng.

Dong quai is specific for relieving hot flashes of menopause. It helps regulate the cycle and diminish spotting and flooding caused by anemia or lack of hormones, as it contains iron, folic acid and B12, and should not be used if excessive bleeding is present.

Dong quai relieves uterine pain via its sedative, warming and antispasmodic qualities, relieving aches or spasms in the joints, uterus or vagina. In addition, Dong quai is a herb of choice because it enhances the circulation, reducing atherosclerosis and blood pressure, and the coumarin content helps to thin the blood. In Chinese medicine, it is considered a blood builder.

Herbalist Susan Weed recommends taking dong quai for 4 weeks followed by ginseng for 2 weeks, and repeat this cycle for 2 years or as long as necessary. Do not use Angelica during pregnancy, if bleeding is heavy, if you have fibroids, if you regularly use aspirin or blood-thinning drugs. If you experience extreme breast tenderness or soreness after taking Dong quai, discontinue use.

Vitex Agnus-Castus (Chasteberry)
Vitex is the single most important herb for regulating periods and reducing menopausal distress. This is useful for women who have premature ovarian failure, or who want to ensure several more months of regular menses. Vitex stimulates the pituitary and helps the body produce progesterone- balances estrogen while favouring progesterone.

Vitex reduces and eliminates severe hot flashes and dizziness, reduces and eliminates endometriosis and uterine fibroids, eliminates flooding, spotting and irregular cycles, and addresses emotional distress.

Vitex gently lowers estrogen levels (protecting reproductive tissues from growths and cancers) and increases progesterone levels (keeping bones and vaginal walls strong) Results become evident only after 2-3 months of daily use; permanent improvement requires about 1 years commitment.

Alfalfa, Red clover and Soybeans
Like Black cohosh, alfalfa is another herb with estrogen-like activities. It is high in nutrients such as vitamin A C D E K and the
B-family. It is also reported to be an excellent natural source of the trace mineral boron (essential for bone building). In addition to these minerals, alfalfa also contains isoflavones, which are estrogenic in action.

A recent study in the medical journal Lancet suggests that the diet of Japanese women may be the reason they experience fewer hot flashes and night sweats than North American women. The traditional Japanese diet is low in fat and high in phytoestrogens (100-1,000-fold more than in American women). Soy foods are expected to be the main source of these phytoestrogens. The Japanese eat about 26 lbs of soy foods per year, while Americans eat about 4 lbs.

Salvia officinalis (Sage)
Since ancient times, sage has dried breast milk and stopped menopausal sweating. There is no other herb so effective at drying up the perspiration that happens with some women's hot flashes.
Sage 's estrogenic effects assist in the hormonal changes of menopause, and it is rich in minerals such as calcium, magnesium, potassium, zinc, and thaimine, having an effect on nerves and emotional swings.

Sage is rich in essential oils that help the stomach and liver produce more digestive enzymes and acids, thus easing indigestion, nausea and gas. The essential oils also are disinfectant and concentrate in the urine, reducing bladder infections. Take 1-2 spoonfuls of the dried leaf infusion three times daily.

Leonurus cardiaca (Motherwort)
Motherwort regulates and tonifies the function of the thyroid, blood vessels, liver, heart and uterus, and lessens the severity, frequency and duration of hot flashes. For best results, use Motherwort frequently for 3 months. It can also be used to relieve faintness and shortness of breath which can accompany hot flashes.
Used regularly, motherwort calms the nerves, and relieves anxiety, releasing held tension. Motherwort is useful for painful periods, eliminating menstrual cramps, especially when associated with anxiety and nervous tension.It encourages strong, but not crampy, uterine contractions, which strengthen the uterine muscle. It strengthens the heart, and a single dose of motherwort can quickly ease palpitations and tachycardia.
Dose: 1-4 grams dried herb equivalent three times daily.

As the ovaries slow down, the production of estrogen and progesterone is taken over by the adrenal glands. Most people in our society are extremely stressed and suffer from some degree of adrenal fatigue often approaching adrenal exhaustion. The tonifying the adrenals helps you create the estrogen and progesterone that is needed to support the body and reduce the impact and symptoms of menopause.

Eleuthrococcus senticosis (Siberian Ginseng)
Ginseng nourishes and strengthens the adrenal cortex. The benefits of taking ginseng are cumulative, and you will notice improvement in 2-3 weeks. Ginseng reduces the intensity and frequency of hot flashes, improves nervous functions, eases anxiety and depression, balances blood sugar, reduces the effect of stress and improves energy levels, reducing fatigue.
Ginseng also has cardiotonic properties, nourishing the heart and blood vessels, lowering elevated blood pressure (without reducing normal blood pressure), increasing HDL (high density lipoproteins, the good cholesterol), and reducing LDLs (low density lipoproteins, the bad fats). There are documented cases of ginseng causing menstrual-like bleeds after menopause . If this happens to you, discontinue use.

The dosage varies more according to the individual plant than among the various species: 0.5-3g/day root infusion or tea daily; 5-40 drops of fresh root tincture 1-3 times daily.
NB Don't use Ginseng if you have a fever or have an acute flu/cold. Some women report overstimulation with Ginseng-too much energy, a sense of being speeded up, like coffee. If this happens, discontinue use. Generally ginseng is not used for long periods in the young and healthy (not for more than 3 weeks at a time), and should be avoided for those who react to stresses with increased nervous tension or anxiety i.e.. children and hyperactive people. It is best not taken with coffee, or in overheated conditions (ginseng is yang).

Glycyrrhiza glabra (Licorace)
Licorace has a restorative effect on the adrenal cortex, supporting the stress response and is used in cases of chronic stress, and adrenal exhaustion. It also has an anti-inflammatory effect on the body by enhancing the effects of cortisone. Licorace is also reputed to have phyto-estrogen like capabilities, and it is important to remember that regular use of licorace can cause high blood pressure and edema (water retention). and is not to be used with those on potassium lowering drugs. If you choose to use licorace, drink no more than a cup/250 ml of tea a day, or chew on a licorace stick as needed.

Strengthening and and supporting the liver and digestive system will reduce your menopausal symptoms. It is also important to address any chronic yeast infections which can worsen menopausal symptoms.

Gentiana lutea (Gentian)
Gentian is a classic bitter herb. Take bitter herbs in a tincture or tea form, as it is the taste which is the most important factor. The bitter taste stimulates hormones in your body to enhance digestive secretions. Gentian should be taken in small doses 15 minutes before meals to enhance digestion. The use of bitters is extremely important in digestive and liver health. They strengthen the digestive system, assisting in the breakdown and absorption of essential nutrients in the body. Gentian also helps cleanse and support the liver.
Dose: 30-60 drops of tincture in a small amount of water 15 minutes before meals.

Silybum marianum (Milk thistle)
Silybum stimulates liver function, in that it is used to increase the secretion and flow of bile from the liver and gall-bladder. Proper liver function is critical to maintaining normal hormone balance. The common milk thistle contains some of the most potent liver protecting and stimulating substances known.
Dosage: 1-4 grams of the seed three times daily. The active constituents, collectively known as silymarin, are not very soluble, therefore the milk thistle preparations most widely used in Europe are standardized to contain between 70-80% silymarin. 140mg of silymarin three times daily is recommended.

Taraxacum off. (Dandelion root)
decoction, is a wonderful gentle tonic for liver function in a wide range of problems. Taken three times daily, it cleanses the liver bowel and kidneys, increasing digestion. It is indicated in gallstones, constipation, and for general toxic conditions such as chronic joint and skin inflammations.
Available in granule form from your local health food store, you can take it as a hot drink three times daily.

Reading:
Hormone Replacement Therapy-Yes or No? Betty Kamen, PhD. Nutrition Encounter Inc. 1993.
Take Charge of Your Body. Dr. Carolyn De Marco. The Well Woman Press, 1989.
Natural Menopause. Susan Perry, Katherine O'Hanlan MD, Addison-Weslay Publishing Co. 1992.
Menopausal Years, the Wise Woman Way. Susan Weed. Ash Tree Publishing , New York, 1992.

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