What is menopause and how should a woman approach this special time in her life?
By Camilla Parham, MD.
Starting with the basics is important. As women, we are often not told enough information about our bodies, and it is embarrassing and disempowering to lack important information. So let us begin with the actual definition of menopause:
Menopause is the time in a woman's life that begins with cessation of her menses if she is over forty years old. Menopause can occur anytime between forty and 65, and the average age at menopause in the United States is 51. If a woman stops menstruating for over a year younger than age 40, this is called "primary ovarian failure" and is treated very differently.
Primary ovarian failure is a pathologic state (an illness). Menopause is not. It is, interestingly, the third physiologic process in a woman's life to be "appropriated" by conventional medicine, and pathologized. First was menstruation, which went from being ignored by physicians to being the source of an alphabet soup of disorders: PMS, PMDD, PCOS, etc (another newsletter topic, for another issue). Then pregnancy and childbirth went from being normal processes to being illness, best managed by conventional M.D.'s in a hospital setting.
Like menstruation, pregnancy, and childbirth, each woman is different and may have her own unique experience of this time of change, metamorphosis, and transformation. On average, one third of American women will go through menopause without any symptoms to speak of, and will simply experience cessation of the menses. Another one third will have mild symptoms of hot flashes, irregularity to menstruation, before it ceases completely, insomnia (often triggered by the hot flashes), vascular headaches, some "fogginess" of mind (transient-this resolves after menopause), and vaginal dryness. The final third of American women experience more serious manifestations of the problems described, requiring more intensive health support.
When we are told what is happening to our bodies during menopause, it is often described as an "estrogen deficiency state". The truth of the matter is, our estrogen levels go down after menopause, but we still have small amounts circulating in our bodies, provided by our ovaries (if we still have them), and by estrogen stored in fat cells. What does not get discussed is the fact that our metamorphosis into menopause is also a time of sky high levels of two other hormones: follicle stimulating (FSH), and lutenizing hormone (FSH). It is a measurement of these two hormones, from blood testing, that conventional doctors most often use to assess where a woman might be, along her journey into menopause.
The Politics of Menopause
Before the mid 1980's, the support given by conventional medical doctors for women with serious menopausal symptoms was usually valium, an anti-anxiety medication. Their complaints were often not taken terribly seriously, and menopause was not seen as a disease.
From the mid 1980's through last year, conventional medicine favored treatment with hormone replacement therapy (HRT). Since the advent of the drug "premarin", the most popular brand of HRT on the market today, menopause has been treated by conventional medicine is an illness, from which women must be rescued.-- all women. In marketing the HRT drugs, the media has implied that HRT will keep a woman "forever feminine", minimizing the changes of aging, sagging reproductive drive, and memory loss, in addition to preventing heart disease, and osteoporosis.
Conventional medicine has just gone through a bit of a flip flop.
In 2004, a National Institutes of Health study underway for three years and designed to go forward into the future for seven more, recording the effects of estrogen on menopausal women was stopped prematurely. Women in the study showed a statistically unacceptable increase in the rates of breast cancer and heart disease.
Before the NIH study, women seeing conventional gynecologists, internists and family doctors were being pressured to start HRT as a preventative measure, being encouraged to use these hormones during the perimenopausal years (while still menstruating, but approaching age 50....) and to stay on these hormones for the rest of their lives. After the NIH study, these same women found themselves struggling not to be cut off of these medications "cold turkey", as the very same doctors changed their recommendations to use of HRT for serious menopausal symptoms only, and for no longer than 3 to 5 years.
Current recommendations apply to SYNTHETIC estrogen replacement therapy, which is made from the urine of pregnant horses (hence the name PREgnant MARe's urINe or "premarin"), which contain not only estrogens found in humans, but several estrogens found only in horses. Some alternative healers believe that the risks associated with use of the synthetic hormones are related to these horse estrogens, which may stimulate inflammatory processes in the human body. Some alternative and conventional healers therefore recommend BIOIDENTICAL hormone replacement therapy. This is HRT made from plants, and containing only the estrogens found in humans. At the present time, there are not "scientific, double-blind, randomized controlled studies" that speak clearly to the safety of such bio-identical therapy, relative to the synthetic HRT.
So, use of ANY HRT must be undertaken with full knowledge that the data is not clear on longer term effects of these therapies.
See also: Another Side To The HRT Story - Bio-Identical Hormones Show Positive Health Effects
Tried and True Therapies
So, remembering that MENOPAUSE IS NOT AN ILLNESS, it is comforting to know that outside the storm of controversy around HRT--synthetic or bio-identical--lies a treasure trove of alternative therapies, used by millions of women, around the world, for thousands of years, for this time in our lives. Lifestyle changes are important: quit smoking, decrease alcohol use, increase exercise, stay active reproductively, alone or in relationship, and use stress reduction techniques. A healthy diet is vital: eat organic, avoiding additives, reduce or eliminate red meat and increase vegetables grains, and fruit, reduce caffeine, refined sugar, and salt, and decrease carbonated drinks ( they leach minerals from our bones).
Kathleen Fry and Claudia Wingo, in "Menopause, Naturally" offer the following tips for a healthy perimenopause:
1. Quit smoking
2. Control stress
4. Be positive
5. Laugh often
6. Nuture your spirit
7. Continue to grow
8. Be physical
There are many herbs from various traditions and cultures that heal, during the menopausal metamorphosis. Black Cohosh, a Native American herb, is useful for hot flashes, headaches, palpitations, sleep disturbances and irritability. Wild yam, a central and South American herb, is useful for digestive troubles, fatigue, and hot flashes. Chasteberry or vitex is very good for hot flashes and relief of vaginal dryness. Vervain, from ancient Egypt, helps with headaches and insomnia. Dong Quai, from traditional Chinese medicine, is a "yin tonic", and helps with fatigue.
Black Cohosh - (cimicifuga racemosa)
Specific symptom relief is also available through acupuncture and acupressure, homeopathic remedies, yoga and ayurvedic medicine, Maya abdominal massage, bodywork therapies, and energy therapies, such as Reiki and therapeutic touch.
The Magic of Menopause
Anyone seen the bumper stickers that say "They're not hot flashes-they're POWER SURGES"?
There is growing science to suggest that this is true. The FSH and LH hormones that go "sky high" during the menopausal metamorphosis are biochemically active on brain cells. This means that the actual chemistry of our brains functions differently postmenopause, than before menopause. Candace Pert, PhD, and Joan Borysenko, M.D. suggest a "grandmother hypothesis". They theorize that it was an evolutionary ADVANTAGE for women to stop their biological creativity around 50 in favor of becoming elders in the tribe, thousands and thousands of years ago. The post-menopausal brain is able to recall events from long term memory more easily, can problem solve more efficiently, and (most impressive?) the entire right side of the brain-our more intuitive side-lights up differently on a PET scan study.
So eat well, keep a positive attitude, use alternative therapies for symptom support as needed, and look forward to your Wise Woman days. They should be an entire third of your life
Dr. Camilla Parham provides insight on current health care issues as a consultant for Heartspring.net. Camilla is a family doctor with 20 years experience in conventional and alternative health care. Board certified in both holistic medicine (American Board of Holistic Medicine) and in family practice (American Board of Family Practice), she enthusiastically joins the Heartspring.net team. Dr. Parham is also currently launching a new venture: "Health Care for Human Beings."