Menopause

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Menopause (and Perimenopause)

What Is Menopause?

Menopause is the time in a woman's life when her period stops. It usually occurs naturally, most often after age 45. Menopause happens because the woman's ovaries stop producing the hormones estrogen and progesterone.

The transition into menopause is called perimenopause, and it can begin several years before your last menstrual period. After a full year without a period, you have been "through menopause."

The average age of a woman having her last period is 51, but some women have their last period in their forties, and some have it later in their fifties.

Perimenopausal and menopause symptoms include:

• A change in periods - shorter or longer, lighter or heavier, with more or less time in between
• Hot flashes and/or night sweats
• Trouble sleeping
• Vaginal dryness
• Mood swings
• Trouble focusing
• Less hair on head, more hair on face

While these symptoms are not life-threatening, they can be so bothersome that they interfere with quality of life. Talk to your care providers about how to best manage menopause. Make sure they know your medical history and your family medical history, including whether you are at risk for heart disease, osteoporosis, or breast cancer.

What Are the Conventional Treatments for Menopause?

Staying healthy during and after menopause may mean making some changes in the way you live.

Since the body has less estrogen during and after menopause, your bones are less able to use calcium, which creates a risk factor for osteoporosis, a condition in which bones weaken and are more likely to fracture. Fractures from osteoporosis can result in pain, disability, and sometimes death. Osteoporosis is a major health threat for an estimated 44 million Americans, 68 percent of whom are women.

Treatments for menopause depend on the symptoms that are most bothersome. These can include:

• Vaginal lubricants (not petroleum jelly) or a vaginal estrogen cream or tablet to treat vaginal dryness and discomfort
• Menopausal hormone therapy (formerly called Estrogen Replacement Therapy) to reduce hot flashes, slow bone loss, and improve sleep
• Antidepressants to ease mood swings and depressive symptoms

The use of menopausal hormone therapy has been highly debated since the Women's Health Initiative Hormone Study findings were released in 2002. Before this study, it was thought that hormone therapy could ward off heart disease, osteoporosis, and cancer, while improving women's quality of life. Findings emerged from clinical trials that showed this was not so, and current research suggests that long-term use of menopausal hormone therapy poses some serious risks.

However, for women who need hormone therapy to control symptoms, the results suggest that short-term use does not increase heart disease risk in women if they begin hormone therapy within 10 years of menopause onset.

More research is needed to fully understand this issue. Still, a woman has options when it comes to managing the symptoms of menopause.

What Lifestyle Behaviors Are Recommended for Menopause?

Lifestyle behaviors that are most important are designed to protect your bones. These include:

• Not smoking. Smoking is a known risk factor for osteoporosis
• Eating a healthy diet [2] that is low in fat, high in fiber
• Getting enough calcium and vitamin D
• Maintaining a healthy weight
• Doing weight-bearing exercise, such as walking, jogging, or dancing, at least three days each week

What Are Some Integrative Therapies and Healing Practices to Consider for Menopause?

In a holistic perspective, menopause is not an illness, but a life transition through which all women pass. However, that does not deny that there are undesirable symptoms sometimes.

Complementary therapies for menopause aim to ease the difficulties of uncomfortable symptoms. The use of complementary therapies for menopause symptoms is common. Women who use them generally find them to be beneficial. A telephone survey of more than 850 women age 45 to 65 showed that 76 percent used alternative therapies, including 22 percent who used them to treat their menopause symptoms. Additionally, as many as 89 percent reported that they found these therapies to be "somewhat" or "very" helpful.

While isolated interventions, such as an herbal medicine or acupuncture [3], may ease a discomfort like hot flashes, isolated symptom treatment alone is not the sole intention of an integrative approach. Integrated approaches focus on bringing the body into optimal balance, which will naturally diminish the physical discomfort. This involves mental, emotional, and spiritual balance as well, which is a healthy goal for any phase of life, including menopause.

Mind/Body Practices

Clinical studies that have examined the impact of exercise [4], progressive muscle relaxation, relaxation breathing [5], guided relaxations, and stress [6] management practices in menopausal and perimenopausal women have not found specific reduction in the specific complaints of hot flashes, night sweats, vaginal dryness, or sleep disturbances. However, there is improvement in overall quality of life, which is a major goal.

Menopause is an ideal time to examine one's life, to find expression and satisfaction with work and relationships, and feel committed to something larger than ourselves-to find purpose.

It is an excellent time to cultivate self-reflective practices, such as meditation [7] and journaling. There are many excellent resources about this time of life, including: The Second Half of Life, by Angeles Arriens, PhD; and The Wisdom of Menopause: Creating Physical and Emotional Health and Healing During the Change, and The Secret Pleasures of Menopause, both by Christiane Northrup, MD.

Botanicals and Supplements

Most botanical supplements [8] used for menopause are thought to provide benefits through active ingredients that act as phytoestrogens-plant substances that act like estrogen in the body. However, the research is mixed on the results.

Typical doses for each botanical are indicated below. However, you should talk with your healthcare provider before adding botanicals to your health regimen and ask about the right dosage for you.

• Soy in the diet has not been shown in trials to improve symptoms better than placebo.
• Isoflavones (avg. 50 mg/day), in well-done studies, have not been shown to be better than placebo at improving specific menopausal symptoms, although some short-term studies suggest improvement in hot flashes.
• Many over-the-counter products combine multiple botanicals to achieve optimal effect, and such combinations have not been well studied.
• Red clover (40-160 mg/day) has also not been better than placebo in studies.
• Black cohosh is one of the most popular over-the-counter botanicals. Early research suggests 40mg/day will improve hot flashes. However, there are concerns about liver toxicity and possible impact on breast tumor development in animal models.

Naturopathic Medicine

Naturopathic medicine [9] may be a good approach for women who desire a natural and integrative approach to menopause, with guidance and support for diet [2], lifestyle, botanicals [10], hydrotherapy, and other tools.

In one systematic study of Naturopathy [11] versus conventional medical treatment for menopausal women, Naturopathy appeared to be an effective alternative, providing comparable relief of specific menopausal symptoms compared to conventional therapy.

Traditional Chinese Medicine [12]

Traditional Chinese Medicine [13] providers work with women to optimize their nutrition [2], activity [14], and internal energetic balance, using herbs [15], acupuncture [3], movement practices [16] (Qigong [17] and Tai Chi), massage [18] (Tui Na [19]), and other techniques. Short-term studies about acupuncture alone have not shown benefit in decreasing hot flashes, but the whole systems approach has not been well evaluated. A one- to two-month trial with a TCM provider may give you an indication of whether this approach is beneficial for you.

Homeopathy [20]

Homeopathy [21] is another approach used by some women to help manage symptoms.  A 2010 summary of research on homeopathy and menopause found mixed results, with a large percentage of women in some studies reporting improvement in symptoms, while two small clinical trials found no statistically significant improvement. The summary concludes that well-designed trials of homeopathy for menopause symptoms are needed.

How to Use Integrative Therapies in Menopause and Perimenopause

As with any medical "condition," educating oneself is of utmost importance. Learn about the changes happening in your body during menopause. Studies show that women who receive educational counseling in menopause are less likely to inaccurately attribute physical pain complaints to menopause.

It is important to learn about the secondary effects of menopause, such as osteoporosis, increased heart disease [22] risk, and memory loss that may possibly be prevented through specific treatments.

If you use botanical supplements, especially if you are also using pharmaceuticals, it is important to inform your health care provider.

Every woman has a different perimenopause experience. Not all women experience problematic symptoms, and those who do experience symptoms to different degrees. Keep track of your recurring issues, when they occur, and what factors impact them so you can make necessary changes.

Most importantly, remember that menopause is a natural phase of life. You might want help with symptoms for a time, but you usually won't need assistance for the rest of your life.

References and Resources

Websites

American Association of Naturopathic Physicians http://www.naturopathic.org/ [23]

National Center for Complementary and Alternative Medicine - Naturopathy http://nccam.nih.gov/health/naturopathy/ [24]

Thompson, E. (2010.) Alternative and complementary therapies for the menopause: A homeopathic approach, Maturitas, Volume 66, Issue 4, August 2010, Pages 350-354, http://www.sciencedirect.com/science/article/pii/S0378512210000538 [25]

U.S. Department of Health and Human Services - Women's health http://www.womanshealth.gov/faq/menopause-treatment.cfm#b [26]

North American Menopause Society http://www.menopause.org/ [27]

Books

Arriens, A., PhD (1999). The Second Half of Life.

Northrup, C., MD (2006). The Wisdom of Menopause: Creating Physical and Emotional Health and Healing During the Change. Bantam Books.

Northrup, C., MD (2008). The Secret Pleasures of Menopause. Hay House Publishers.