Alternatives
for Menopause – Part I
The medical definition of Menopause is the cessation of menstrual
periods for 6-12 consecutive months due to exhaustion or elimination of ovarian
function. Before menstrual bleeding stops, and
even after, the ovaries go through various stages of change in their hormone
output, and these are reflected by the well-known symptoms and signs of peri-menopause
and menopause. I will provide more details about
this in Part II.
Menopause is a totally natural stage in a woman's life. So may be many of it's consequences, such as bone loss, genital atrophy, increased heart disease and reduced levels of function in many areas. Or, are these consequences modifiable or avoidable? Many of our ancestors living as little as 150 years ago did not get a chance to find out, as many women died before reaching menopause, due to complications of pregnancy and various infectious diseases. Now that most women in western societies can hope to live into their 80's or 90's, the question of how to approach the menopause has come more sharply into focus.
Many readers by now are aware that the use of horse-derived estrogens and semi-synthetic progesterone to treat women with menopausal and other symptoms are no longer considered safe and effective practices, in spite of official assurances to the contrary since the 1950's. The prematurely terminated Women's Health Initiative (WHI) with the associated Journal of the American Medical Association(JAMA) papers in 2002-3 brought this to the attention of the medical and general public. The study found increased incidences of breast cancer, heart attack, stroke and blood clots to the lungs in the treatment groups compared to the placebo groups, in spite of benefits in reducing bone loss and menopausal symptoms in many subjects.
The WHI results have led many women to stop hormonal therapies, and to seek alternatives. These may include: changes in diet, activity and lifestyle; dietary supplements; herbal products; bio-identical hormone replacement/therapy (BHRT). The basic health and preventive needs which arise at menopause include: maintenance of bone density/prevention of fracture; physical changes of aging; alterations in mental function and mood; menopausal symptoms, such as hot flushes, abnormal bleeding, fatigue, sleep disturbances; prevention of cancer, heart attack, stroke, and other degenerative diseases. I will describe diet, lifestyle, exercise and nutritional supplements in Part I, with the herbal and the most controversial, BHRT, in Part II.
It appears that diets high in fat and red meat and total protein increase the dietary needs for calcium and magnesium, minerals important for bone formation. These are unfortunate characteristics of the typical American diet. Moderating these factors should improve bone health, as well as reducing heart attack and stroke. Overeating leads to increased body fat, which acts not only to store energy, but also the sex hormones, and to even synthesize them. This may be a reason for the association of overweight and uterine and breast cancer. The fat tissue will release stored estrogens, leading to an imbalance that will promote these conditions. Also, women with more body fat seem to have more menopausal symptoms and disorders. So, calorie reduction, and achievement of ideal body weight is important in prevention of disease and severe menopausal symptoms. Consumption of ample calcium and magnesium in the diet and avoidance of items that reduce their absorption are important. Dairy products have been a traditional source of the minerals, but consumption of legumes, soy, dark greens and fish are important dietary components. Soy and other legumes contain isoflavones, which stimulate bone growth, and often reduce menopausal symptoms.
Regular, aerobic, weight-bearing activity helps to maintain fitness and ideal body weight and composition. It is also research-proven to reduce depression, anxiety, sleep, menopausal symptoms, and to improve bone density and overall wellbeing. Some experts advocate 30 min of training per day on average. For best results, it is important to have some form of concentrated work-out 4-5 times/week, which should include resistance training for the upper body. This is particularly important for women, as the upper body strength has proven benefits in preventing the hip-fracturing falls that are the scourge of the elderly. The weight-bearing activities such as walking, running, stair-stepping, skiing, elliptical training, are very important for the bones, following a "use it or lose it" principle.
Dietary supplements have been a controversial area at times. Many conventional medical practitioners will simply recommend an RDI-level multivitamin and some added calcium. Not all calcium is created equal. For instance, calcium carbonate (chalk or oyster shell) is not well absorbed by some people, especially with reduced stomach acid. The best absorbed forms are Calcium Citrate and Calcium Hydroxyapatite (a mineral similar in composition to bone). Supplementing with 800-1200 mg daily with these is probably sufficient. However, even the best forms of calcium will not be absorbed or utilized without adequate Vitamin D. Vitamin D is actually a hormone that we make and activate in our skin, liver and kidneys. We use calciferols, found in vegetable and animal sources, in order to make it. We may take animal-derived vitamin D-3 as a supplement, but won't make enough active vitamin without ultraviolet light exposure. So, covering up too much body area or using excessive sun screen can actually reduce vit. D levels, although these practices have benefits in preventing skin cancer. I have found it useful to measure blood levels of "25-OH-Vitamin D", which is the partly activated form made by the liver. If these levels are low, supplementation is definitely useful. Daily intake of from 1000-5000 units of Vitamin D3 (cholecalciferol) are now recommended. Magnesium also must not be neglected. Population studies indicate that many women are relatively deficient in this mineral, which is calcium's partner in many metabolic activities. Inadequate amounts may reduce the effects of calcium, and lead to nervousness, sleep disturbances, constipation, increased muscle tension and palpitations. Magnesium is found in chlorophyll, which makes green vegetables green, in legumes, in calcium-rich foods, and is rich in some nuts, such as almonds. If you supplement with it, use the Citrate, Glycinate, or Aspartate for best absorption, 400-800 mg/day. If it produces loose bowels, just back off a little. Soy isoflavones in purified form may be useful for some women. These chemicals will bind to estrogen and progesterone receptors, and partly improve menopausal symptoms, and there is some evidence for improvement in bone health. However, some are concerned there could be risk associated with consuming the extracts as opposed to the whole foods.
A number of plant extracts, in addition to soy isoflavones, have been utilized for menopausal symptoms. These include: Black Cohosh; Dong Quai; Red Clover; Chaste Tree Berry. Black Cohosh, as a German standardized extract sold as Remifemin™ has the most research data behind it for controlling hot flashes. The usual doses are 20-40 mg twice daily. Chaste Tree, also known as Vitex, is useful in peri-menopausal aggravations of PMS, which are often due to decreases in progesterone levels. Red Clover is also useful, but has less data behind it. Dong Quai by itself may help to regulate a chaotic menstrual cycle, but is not proven for hot flushes. It is often found as part of Chinese herbal formulae for women. Caution should be used with Dong Quai and Red Clover, as they have a mild anti-coagulant ("blood thinning") effect. This is not an exhaustive list of useful herbs; I have listed the ones with which I have the most experience, and which have the most research data.