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| NATUROPATHIC TREATMENT OF MENOPAUSE | ||
By Steve Morris, N.D. Perimenopause is a time of fluctuating hormones and related symptoms leading to menopause. During perimenopause the production of sex or reproductive hormones (estrogen and progesterone) begins to decline resulting in a shift from a regular to an irregular period cycle and eventually none at all. Some women may begin to experience perimenopause in their late thirties. Yet, it more typically lasts from two to eight years and on average commences around age 47. During this time a woman may experience both the symptoms of PMS and menopause in varying degrees or no symptoms at all. Some of the symptoms perimenopause women have reported include: • Menstrual flow becoming heavier and lighter The arrival of “postmenopause” is signified by one year of having no menstrual periods. During the early stages of postmenopause, perimenopause symptoms usually contine and may even increase as estrogen levels continue to decline. Currently there are over 40 million post-menopausal women in the United States. In light of their relative populations, this suggests there are approx. 4 million postmenopausal women in Canada. The great misconception is that sex hormones are depleted and the woman feels her life is changed from the way she previously experienced it. However, the adrenal glands take over many of the endocrine functions responsible for libido, and produce androstenodione, which is converted to estrogen in the form of estrone. Also, the adrenal glands as well as the liver and adipose tissue produce 50% of the women’s testosterone. Post-menopausal ovaries continue to produce androgens, low levels of estrogen, and other testosterone. Postmenopausal ovaries continue to produce androgens, low levels of estrogen, and other sex hormones, which potentiate sexual arousal. Signs and symptoms of menopause can range from mild to severe. Clinically, we have experienced that the primary emphasis should be placed on the prevention of diseases, which correlate with decreased estrogens; in particular osteoporosis, urinary dysfunction, of diseases, which correlate with decreased estrogens; in particular osteoporosis, urinary dysfunction, depression and stress-related conditions, thyroid dysfunction, loss of cognitive function, and heart disease. The symptoms usually associated with menopause are hot flashes, night sweats, insomnia, vaginal thinning and dryness, decreased libido, heart palpitations and increased risk of vaginal and urinary tract infections. Saliva testing is used in determining excesses and deficiencies of six major sex hormones; estrogens (E1, E2, and E3), testosterone, progesterone, and dihydroepiandosterone. In further evaluation and prevention of disease, the health practitioner may use lifestyle, nutrition, applied nutrition, exercise therapy, botanical remedies, and natural hormone therapies relative to the severity of signs and symptoms and clinical laboratory findings. Vasomotor signs and symptoms consisting of hot flashes, night sweats, and insomnia may be due to changes in lifestyles, primarily due to phytoestrogen content of foods, and secondarily due to neuroendocrine function of the thyroid, pituitary and hypothalamus glands. Because of hot flashes, many women have severe insomnia, which may lead to poor mental and physical health. Poor mental health may be seen as depression, anxiety, and/or decreased cognitive function. Many post-menopausal women should be evaluated for thyroid imbalances. At our clinic we primarily utilize saliva testing for evaluation, however, an accurate and inexpensive method is to average 1st morning basal body temperature over 30 days. The presence of hypothyroidism should be determined through medical history and testing. This may present itself as fatigue, depression or malaise. Hyperthyroidism may present itself as anxiety, tachycardia, or insomnia. Both forms of imbalance can be treated effectively by naturopathic means. Changing hormone levels, increased stress from socio-economic and/or poor relationship interaction and communication primarily causes decreased libido in menopausal women. Through careful observation these can be differentiated and addressed properly. The adrenal glands and ovaries produce many of the hormones responsible for normal libido. These are also evaluated through saliva and/or serum testing. Saliva testing for estrogens, DHEA testosterone and progesterone is recommended. Serum estrogens, FSH and LH levels and testosterone tests are also available. Decreased estrogens are responsible for vaginal mucosa thinning and dryness, which result in painful intercourse thereby interfering with decreased desire to be intimate. Due to decreased tone and coordination of urinary tract organs, involuntary loss of urine is common in post-menopausal women and can be easily corrected through lifestyle management and applied botanical nutrition. Osteoporosis is increasingly prevalent in sedentary western societies. Weight bearing exercise and calcium/mineral rich whole foods are preventive when applied. Bone density testing remains the best diagnostic tool in concert with laboratory findings and medical and family history. Sounds naturopathic treatment, without the side effects of allopathic medicines, i.e. Fosamax, can result in excellent positive bone growth when holistically applied by a skilled N.D. or experienced holistic M.D. Cardiovascular disease is the leading cause of death in both women and men. Generally this is the reason more women are prescribed HRT, however, it is not conclusive that estrogen replacement even plays a significant role in preventing heart disease, especially when severe side effects such as cancer are factored into the equation. Naturapatic prenvention and treatment of cardiovascular disease is not only effective, but also safe. The only issue at hand is if the patient is willing to modify her lifestyle by decreasing dietary cholesterol fat, increasing cardiovascular exercise and moderating stress through mediation. As naturopathic doctors, we must address lifestyle management as part of the treatment protocol, usually not offered by our allopathic peers. Hormone Replacement Therapy Prior to July 2002, hormone therapy had become the standard means of treating menopausal symptoms as it was believed to address the common discomforts (hot flashes and vaginal dryness) and we also considered effective protection against the most serious postmenopausal conditions such as osteoporosis and heart disease. Then in July 202, the Women’s Health Initiative study – a large, multi-tiered clinical trail (sponsored by the National Institutes of Health) concluded that hormone replacement therapy (HRT) may actually impede more than benefit a women’s health. The Women’s Health Initiative study was actually two studies – one involving estrogen alone and the other involving estrogen and progesterone. In the combination study (estrogen and progestrin) involving postmenopausal women (average age 63) researchers observed an increased risk of heart disease, breast cancer, stroke, blood clots and dementia. Furthermore, in the case of breast cancer HRT made the tumors harder to detect, thereby increasing the risk of late detection. In the estrogen-only study a slight increase in the risk of stroke was observed. In the case of treatment with estrogen or estrogen-progestrin, contrary to prior claims, there was no indication of a prevention of dementia. Instead study results point to an increased cognitive impairment as a result of HRT. Furthermore, the WHI study found that the combination HRT did not achieve measurable improvement in relieving milder menopausal-associated quality of life considerations such as general health, sexual satisfaction, physical health and sleep. The findings of these studies have resulted in a major shift in the conventional wisdom respecting the treatment of menopausal-associated symptoms. HRT is no longer considered the treatment of choice that it once was. This in turn has caused many women and their health practitioners to consider other alternatives. Natural remedies are well suited to addressing the symptoms and disease entities realated to perimenopause and postmenopause and at greatly reduced or no risk associated resulting from their use. Treatment Protocols The naturopathic treatment of menopause is holistic in breath. Not only do physical symptoms need to be addressed, but also emotional, spiritual, and psychological signs need to be recognized and taken into account. Nutritional factors that are pertinent include a whole food, low fat diet rich in isoflavones from soy, other legumes, spinach and fruits. Epidemiologically indigenous, equatorial women eat a diet rich in isoflavones and do not experience most menopausal symptoms until they adopt a western diet. Lifestyle factors such as regular cardiovascular aerobic exercise is also important in avoiding serious health conditions i.e. heart disease, diabetes, etc. Furthermore, stress management should be included, since postmenopausal women may be under undue stress and tension. Regular meditation, visualization and yoga are counteractive to stress. Nutritional supplementation is very helpful in reducing severe signs and symptoms of menopause. Although they may not be curative, their effects will be noticeable. Black Cohosh (cimicifuga racemose rhizomes) is high in the tri terpenoid glycosides; cimicifugacide and acetein., Black cohosh is a safe and effective treatment for insomnia, hot flashes, night sweats and other menopause symptoms. Red Clover (triolium praetense) is a legume rich in isoflavanoids, exihibiting phyto-estrongenic activity. Isoflavones have a structure similar to naturally occurring steroidal sex hormones. A double blind placebo test in the Netherlands in 2002 observed that use of red clover extract decreased hot flahes by 44% between the active and placebo group. Chasteberry stimulates pituitary function, improves the production of progesterone, increases luteinizing hormones and prolactin and inhibits the release of follicle stimulating hormone. It is helpful in reducing or eliminating PMS symptoms (which often re-occur during perimenopause), and help control depression, hot flashes and vaginal dryness. Dong Quai (Angelical sinensis) is the second most widely used herb in China (behind ginseng). Its anti-inflammatory and antisposmatic properties make it popular for reducing symptom of PMS and helping to regulate the menstrual cycle. In combination with other herbs, the phytoestrogen is useful in controlling hot flashes and reducing vaginal dryness. These and other botanical ingredients have been combined in creating two favorite formulas: Peritrol and Menoplex. Peritrol relieves symptoms associated with perimenopause and Menoplex is effective in hormonal balancing and in addressing postmenopausal symptoms. After years of working effectively with these formulations in my own naturopathic practice, I have agreed to commercialize their use through Biomed International. Due to inconclusive evidence respecting the long-term effectiveness of soy isoflavones in treating menopausal symptoms (such as hot flashes) neither of these formulas includes soy. Other recommended nutrients beneficial for women to take include: vitamin E, viamin B-6 and evening primrose oil. These can be taken separately or obtained through a good women’s multi-vitamin, such as Biomed’s MultiFem. Osteoporosis Estrogen plays an important role in maintaining calcium in the bones and aids in the absorption of calcium and other minerals vital to bone formation. Consequently, declining levels of estrogen after menopause is a leading cause of osteoporosis in women. A diet rich in minerals such as calcium, boron and magnesium is an important means of treating the causes of osteoporosis. Indigenous diets rich in minerals, potassium, calcium and trace minerals prevent most chronic degenerative diseases. Yet, the modern North American diet is often lacking in adequate quantities of these essential minerals, resulting in the need for supplementation, especially by menopausal women. Formulated as a combination of minerals, herbs and vitamins, Osteopause has been designed to increase bone density and prevent osteoporosis. The use of ipriflavones, vitamin D3 in combination with the botanicals Equisetum arvense (Horsetail), Taraxicum officinalis (Dandilion) and Zingibre (Ginger) helps with the assimilation and absorption of calcium, magnesium and boron, which are also in Osteopause. Ipriflavone, a flavonoid compound found in soybeans and other plants, acts like estrogen in the body. For postmenopausal women, ipriflavone supplements helps to maintain bone density and strengthens them to guard against fractures. Taking both vitamin D and calcium enhances Ipriflavone’s bone-strengthening effect. The use of calcium citrate/matlate in Osteopause adds to its effectiveness, as it is up to six times more soluble than either calcium citrate or calcium malate. Urinary Tract Infection (Cystitis) Many women experience urinary tract dysfunction in postmenopausal years. The combination of botanicals in Cystinol address: incontinence with Curcubita pepa (pumpkin seed); infection with Vaccinium macrocarpon (cranberry fruit) and Arctostaphylus uva-urse (bearberry) and urinary symptoms by strengthening and acidifying the urinary tract. A diet rich in bioflavanoids, found in the berry family is a delicious nutritional dietary supplementation. Drinking adequate amounts of pure water not only hydrates the body but also helps elimination of unwanted cellular waste products. Adrenal Support Condition such as fatigue, sleeplessness, depression, anxiety, weekend immune system and weight gain are all symptoms often associated with menopause. Yet, they are also signs of dysfunctional adrenal glands. Recommending an effective means of improving a women’s adrenal health is an effective means of making the transition through menopause more comfortable for her. While practicing stress management in paramount, one can also “feed” the adrenal glands by supplanting with appropriate phytonutrients as contained in ASF (Adrenal Support Formula). Botanicles such as Eleuthnococcus sen. (Siberian ginseng), Glycerrhiza blabra (Licorice) and Rhodiola rosea (Arctic root) combined with Vitamin B-6 and C creates an excellent combination product able to contribute to healthy adrenals. Rhodiola rosea is an adaptogen, which increases the amount of b-endorphin in the blood plasma, which has the effect of inhibiting the hormonal changes indicative of stress. Thyroid Dysfunction Hypothyroidism may present itself in the form of depression and fatigue. Careful laboratory analysis will determine if this is a case of hypothyroidism. As health practitioners, we must encourage our patients to take responsibility of their own health. This may involve psychological counseling, exercise therapy, and appropriate nutrition. Hypothyroidism is easily corrected by natural therapies including supplementation of L-tyrosine, iodine, glandular extract and selenium supplied by BioThy. Heart Disease Prior to menopause a woman is at a reduced risk of heart disease compared to a man of the same age. Yet, following menopause a women’s susceptibility to heart disease increases steadily so that by the time she is 65 year of age, she is at a similar level of risk as a male of comparable age. The reason for this is that prior to menopause estrogen seems to provide a women’s heart and circulatory system with a level of production which subsides as estrogen levels decline with menopause. Unfortunately, dietary estrogens found in animal products (meat and dairy) and xenoestrogens found in plastics, may cause confusion. Proper laboratory analysis of cardiac enzymes, lipid analysis, EKG and echocardiograms are recommended for menopausal women. In addition to lifestyle and dietary consideration such as regular exercise and reduced consumption of fats, treatment with natural supplements can be beneficial. For instance, treatment with Cholestiplex can help to modulate cholesterol levels and treatment with co-enzyme Q10, taurine and vitamin E in Co-Q10 Supreme can assist by being preventative. In conclusion, naturopathic and holistic physicians can appropriately treat perimenopause and postmenopause and their associated symptoms and health complications by applying principles of lifestyle management and supplementation. Diagnostic workup is essential in addressing major disease processes. When a partnership between patient and practitioner is developed, we find we have the ability to effectively manage all the signs of menopause while doing no harm. References: 1. Women’s Health Initiative Web Site (www.nhlbi.nih.gov/whi), 2004. |
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