Coping with the Menopause

Many patients comment that they hope to avoid the terrible hormonal symptoms and changes that they saw their mother endure when she went through the menopause. The menopause is simply the cessation of menses and this happens at an average age of 52 years. It is often preceded by a decade or so of symptoms which include chronic fatigue, weight gain, mood swings, unstable blood sugar, and rapid deterioration of the skin.

 

The emotional, mental and spiritual aspects of a woman’s existence are integrated with the physical and hormonal to determine how she reacts to the changes her body will experience.

 

The biggest challenge for any woman approaching the menopause is dealing with the massive amounts of information that are now available. In order to determine her own approach to the menopause it is important for each woman to learn to assess her own body and where she sees the problems that she may already have, what is available to help and what course of action she wishes to embark on.

 

 

DIAGNOSIS OF THE MENOPAUSE

 

The menopause is a specific event that is defined by the loss of menses or changes in blood tests such as an elevated FSH level. Salivary radioimmunoassay tests are now available to measure active levels of the various hormones.

 

Changes begin to occur long before the menopause which is best thought of as a gradual process which has its’ origins in earlier hormonal changes, genetic factors, diet, lifestyle and outside influences such as drugs or environmental toxins.

 

Your personal approach to the menopause will be influenced by the significance in your own life of other factors such as breast cancer, osteoporosis, mood disorders and premenstrual syndrome.

 

MANAGEMENT OF THE MENOPAUSE

 

A personalised program to achieve hormone balance is devised in consultation with each patient. This is involves attention to the following:

Education

The education process never ends and it is important to make a regular reassessment of your treatment. Remember to ask your doctor if he or she feels that you are still receiving the best treatment. Read widely but avoid jumping to conclusions and believing the latest news headlines.

Dietary assessment

Commonsense is the best guide. Avoid a diet high in carbohydrates. Research shows that a high carbohydrate diet results in hypoglycaemia which contributes to oestrogen dominance. Protein helps stimulate growth hormone and muscle bulk. Most women in western nations consume a high carbohydrate diet, resulting in an over-production of oestrogen. The activity of the principal oestrogen hormone, oestradiol, also increases. Population studies have shown that a protein and vegetable based diet is the ideal way for women to stabilize their oestrogen levels throughout life. In Japan, where such diets are common, breast cancer is rare.

 

Osteoporosis is a very common problem. Over 25% of women aged 60+ have compression fractures of their vertebrae, and many develop hip fractures due to the gradual loss of bone. But oestrogens are not nearly as good at protecting the bones as women may be led to believe, and they rarely arrest bone loss. At best, oestrogens simply slow the rate of bone deterioration.

 

Consumption of carbonated drinks will lead to a further loss of calcium and should be avoided. Cutting salt intake can reduce calcium losses even further. Limiting caffeine consumption will hold onto still more calcium, and if patients don't smoke, they will avoid the 10% loss of bone that plagues chronic smokers.

Vitamins and supplements

Taking vitamin E is said to help, but it must be natural vitamin E, not synthetic. The ingredients list on the label should say D-Alpha Tocopheryl. If it says DL-Alpha Tocopheryl or has the word 'acetate' it's not what you want - it's synthetic. Vitamins B5 and B6 are both good for hot flushes and other symptoms. A B-complex vitamin should also be taken to prevent the other B vitamins from becoming unbalanced. Borage Oil, Evening Primrose Oil, and Flaxseed Oil are sources of essential fatty acids that help with many of the symptoms of menopause. Others prefer the benefits of ginsing, dong quai and other herbs.

Lifestyle advice

Lifestyle decisions are an important part of management of the menopause. The changes of the menopause may help encourage you to finally break the smoking habit, lose weight or get fit.

 

For heart disease, hormones are no match for lifestyle changes. Research has shown that a combination of a low carbohydrate diet, mild exercise, stress reduction, and smoking cessation is powerful enough to actually reverse heart disease in 82% of patients in one year. Many doctors claim that patients want pills.It is patronising to assume that every postmenopausal woman is too wedded to her current diet and lifestyle to listen to competent advice. The real problem is, she is not likely to find such advice. Most doctors know little about how diet affects health as the emphasis in their medical education remains the use pharmacology.

Hormone supplementation

This might involve transdermal progesterone, phytoestrogens, dietary supplements or traditional medications. The emphasis is on formulating an individual program for each patient with a preference for minimal treatment and natural hormone sources. Many experts now agree that the key to successful management of hormone balance is to provide each individual patient with what she needs to restore this balance.

 

HORMONE SUPPLEMENTATION

 

The basic principles of treatment are:

minimal treatment necessary

avoiding oral medication

natural hormone sources

safety first

 

Progesterone

Natural and synthetic progestins are readily available. Transdermal progesterone enables the problems of oestrogen dominance can be minimised. Much higher doses are required orally.

 

Oestrogen

Oestrogen replacement is essential to prevent hot flushes and vaginal dryness. A wide variety of treatment options are available.

 

DHEA and Pregnenolone

DHEA can be converted by the body into other hormones including estrogen and testosterone. In a study of postmenopausal women administering DHEA increased serum levels of both testosterone and oestrogens (oestradiol and oestrone). DHEA may also be capable of raising the levels of progesterone. Both DHEA and progesterone are produced from the same precursor hormone, pregnenolone. If enough DHEA is present, then pregnenolone will be converted primarily to progesterone, rather than to DHEA. More needs to be known about the interaction of DHEA and the other ovarian hormones. DHEA supplementation with oestrogen and progesterone may enable lower doses of all of the hormones.

 

Testosterone

Postmenopausal Testosterone replacement remains, although widely practiced, more an art than a science depending more on the woman's subjective response than any clearly measurable parameters.