MENOPAUSE: Handling the Symptoms Naturally

Many women in their forties or fifties believe they have menopause or that they are going through "the change". Menopause is indeed a transitory period in a woman’s life, much like the adolescent years, but it is not a disease to be treated with drugs, as if something is abnormal.

Strictly speaking "menopause" simply means the cessation of the periods, and this generally occurs any time from the mid forties through to the mid fifties. Many other cultures don’t use such a term. Rather than looking upon menopause as a major inconvenience, they see it as a cause for celebration and as a move from the childbearing "mother", years to the older "wise woman" who is looked up to and respected.

Unfortunately we tend to view it as the end of our sexuality, with flagging libido and memory, osteoporosis, wrinkles and other areas drying up! Certainly some women do have a troublesome transition and find it quite difficult while others coast through it relatively smoothly, with few symptoms. It is true that some women do need the help of hormone replacement therapy as their symptoms are so severe, but most just need some support and that is where herbal and nutritional medicine can assist. Culture, diet, environment and stress all play a part in how women experience menopause.

The transition usually lasts a few years but there is what is termed the pre or peri-menopause that may start as early as the late 30’s. This is when a woman may notice her periods becoming more irregular, weight gain, fluid retention and mood swings. Then again some just stop and never have a period again! Let’s examine what happens in a normal menstrual cycle so we can understand better what happens in menopause.

The first day of the period is the first day of the menstrual cycle. Theoretically, day 14 is mid-cycle, when ovulation (egg release) should occur and by about day 28 or 29, if no fertilisation has occurred, the cycle ends, the uterus sheds its bloody lining and another period starts.

Oestrogen is the main hormone secreted from days 1-14 with follicle stimulating hormone (FSH) which stimulates follicular development. The follicles in the ovaries develop the egg to maturity and as the oestrogen levels rise, just before mid-cycle, FSH and a hormone called luteinising hormone (LH) cause the release of an egg from the follicle. This first phase is called the follicular phase.

After the egg is released the follicle becomes the "corpus luteum" and starts to produce progesterone, which is the main hormone in this second phase and maintains the uterus for a fertilised egg to take hold in. The increase of progesterone at ovulation also causes an increase of about 0.5? Celsius in basal body temperature (one sign of ovulation). This phase is called the luteal phase and if pregnancy does not occur, the progesterone and oestrogen levels fall, triggering the monthly bleed.

During the peri-menopause, periods become erratic and women start to have cycles without ovulation, but still produce enough oestrogen to build up the uterine wall and initiate a period. But without the release of an egg, the corpus luteum can’t make enough progesterone and these women experience what we call a relative "oestrogen dominance". Progesterone is low, and therefore the ratio of oestrogen to progesterone is too high. Symptoms of this can include heavy bleeding, water retention, breast swelling/tenderness, mood swings and insomnia.

Oestrogen dominance can also be caused by xenoestrogens, which are outside sources of oestrogen, such as HRT and the oral contraceptive pill, OCP residue in unfiltered water, hormone-fed meat and poultry and other things that can act like hormones, such as plastics, household chemicals and pesticides etc. Our fatty tissue also produces oestrogen, so overweight women can be oestrogen dominant. Progesterone may be normal in these cases but the ratio is low compared with the excessive oestrogens.

Oestrogen production becomes increasingly erratic veering between high and low levels. In fact things can be quite complex and all hormones can be all over the place! As oestrogen levels decline, FSH and LH increase. High FSH and LH levels indicate that the ovaries are no longer producing eggs as the body continually increases these hormones to try to promote egg production. It has been found that hot flushes coincide with bursts of LH. While oestrogens drop at menopause, they only do so by about 15%, whereas progesterone drops much lower due to lack of ovulation and testosterone drops by about 15%. It is this latter hormone that can contribute to many menopausal symptoms. 25% of it is derived directly from the ovaries, with 25% from the adrenals and the rest from other conversions. We will see how important it is to support the adrenal glands through menopause later.

It is important for women, when they see their Doctor for a hormone test, to also insist on the progesterone, testosterone, LH and FSH levels to be tested. Otherwise oestrogen levels may show as normal and he sends her off saying her symptoms must be emotional or just something women must put up with.

Hot Flushes
Phyto-estrogens are plants or herbs that have compounds in them that have a similar chemical structure to oestrogen, though they are much weaker. They can work in cases of too much or too little oestrogen, with a balancing effect. In menopause, with declining oestrogen levels, they work by occupying otherwise empty oestrogen receptors and making the body think there is enough. The following may assist in lessening symptoms: like flushing.

• Black Cohosh
• Red Clover
• Wild yam
• Tribulus
• Shatavari
• Korean Ginseng

It is also good to include more phytoestrogenic herbs in the diet, such as soy foods and other legumes, licorice, peas, beans, alfalfa, fennel and linseeds.

Sweating
Though this is usually thought of as the same as hot flushes, and is often treated with the same herbs, it can also be caused by stress and an over-activity of the sympathetic nervous system. Sometimes improving adrenal function and sleep quality may help.

• Sage and Zizyphus
• Passionflower, Hops, Valerian and Chamomile for sleep.

Irritability, Depression & Low Mood
It is not really understood how the hormones affect mood and emotions but the menopausal years are often fraught with angry outbursts and teary moods! Certainly supporting the nervous system, as mentioned above, helps, but the herb of choice is probably St Johns Wort. This combines extremely well with Black Cohosh but do check with your healthcare professional as it has quite a few contraindications with other medications.

Bone Health
There are three main factors affecting bone mineral density – oestrogen, weight bearing exercise and minerals. Post menopause, exercise becomes even more important; with weight bearing exercises like yoga and walking that are great for maintaining good strong bones. If you think your diet may be low in calcium, supplements are a cheap insurance measure. Always look for a formula with Vitamin D and Magnesium to aid with calcium absorption and to make sure that it utilises good well absorbed forms of calcium like citrate, hydroxyapatite, orotate and chelate.

Adrenals
It is important to support the adrenal glands before, during and after menopause, because they end up taking up some hormone production. The precursor to all hormones is cholesterol (so we do need some!) It converts to oestrogen and other hormones.

Once the ovaries eventually shut down, the two other major sites of hormones are the adrenals and peripheral conversion in fatty tissue. It has been found that some women suffer from worse hot flushes and have a worse menopause overall if they are stressed and adrenally exhausted.

Herbs and nutrients that can help support the adrenals are:
• Withania (Winter Cherry or Ashwagandha)
• Licorice
• Rehmannia
• Korean and Siberian Ginseng
• Vitamins B5 and C
• Magnesium

Liver
Oestrogens pass through and are metabolised by the liver. The liver conjugates them into a less active form and they are excreted with bile. Some are excreted in the urine and faeces and some are changed back into the active form. In times of hormonal irregularity, it is especially important to support good liver function. Herbs, nutrients and foods that help this include:

• St Mary’s Thistle (Milk Thistle)
• Dandelion
• Schizandra
• Globe Artichoke,
• Broccoli, broccoli sprouts, Brussels sprouts and the cabbage family
• Garlic and onions
• Choline, Inositol and Methionine
• B6, B12 and Folic Acid
• Vitamin C
• Fibre and Probiotics for good bowel function and elimination

The liver likes lots of fresh raw food such as salads and juices, as well as sprouts, lemon, essential fatty acids and fresh nuts and seeds.

With a little care of the body and soul, you can get through a few years of discomfort, relatively comfortably. If you have or have had any cancer or major health issues please consult a naturopath or herbalist first, as some of the herbs may have interactions.

Sara Hopkins is a Naturopath who has worked in the Complementary Medicine industry for the past 8 years. She currently works for one of Australias leading Complementary Medicine manufacturers in Customer Support, Technical Research and Health Writing