Menopause Naturally- How
to Deal with Hormonal Changes
By: Karlene Karst, Dietician
Source: Health N Vitality Magazine
Date Published: November 2002
Menopause may be a natural
progression in life, but it is one met with trepidation by many women.
Hot flashes, night time sweats, sexual changes, and the increased risk
of osteoporosis, cardiovascular disease and breast cancer are just a
few of the concerns for women entering this stage of life. Traditionally
women have been offered a very limited range of treatment options by
their physician to help their bodies adjust to the declining estrogen
levels and the physical changes that coincide.
Hormone replacement therapy
(HRT) has been the normal course of treatment, but the decision to use
it is a difficult one because, while research has shown that HRT is
effective for relieving menopausal symptoms, there are also many known
potential health risks and uncertainties resulting from long term use.
In July 2002, the National Heart, Lung, and Blood Institute (NHLBI)
of the National Institute of Health (NHI) concluded there were more
risks than benefits for HRT. They stopped a major clinical trial in
which the treatment of estrogen combined with progestin showed increases
in breast cancer, cardiovascular disease, stroke and blood clots in
study participants compared to women taking placebo pills. There were
benefits including fewer cases of hip fractures and colon cancer, but
the harm far outweighed the benefits.
As a result of the negative
potential side effects of HRT, women have begun to increase their use
of alternative medicine to help relieve menopausal symptoms. During
2000, women spent approximately $230 million on supplements for the
symptoms of peri-menopause. The natural health food industry has been
a long time advocate of natural supplements and treatments for menopausal
symptoms ranging from acupuncture, phytoestrogens (including those from
flaxseed), herbal products such as dong quai, black cohosh, and dietary
food sources such as soy. Currently the NCCAM (National Center for Complementary
and Alternative Medicine) is conducting research on several natural
products that have shown promise for reducing menopausal symptoms to
determine their safety and efficacy. Awareness of these alternatives
to HRT needs to be promoted in order for women to make educated decisions
about their treatment options.
What is Menopause?
There are actually three
stages of what is generally called "menopauseMenopause" including
perimenopause, menopause, and postmenopause. By incorporating all three
stages, menopause is the term used to describe a normal physiological
process in a woman's life, specifically, the permanent cessation of
menstruation that occurs between the ages of 40 and 60, with the average
age being 51. Perimenopause begins before menopause and is the transitional
period from the time of normal menstruation to no menstruation. The
symptoms associated with menopause such as hot flashes and irregular
menstrual cycle may start to appear.
Up to 85% of women may suffer
from various symptoms during menopause. It is an extremely individualized
experience, with varying degrees of symptoms, and is diagnosed when
a woman has been without menses for one year. Fluctuations and decreases
in the levels of estrogen and progesterone lead to physical changes
during the perimenopausal and the menopausal periods.
Irregular menstrual patterns
with changes in length of bleeding, time between periods, and level
of flow is very common in the perimenopausal period. Hot flashes and
sweating are also common and may continue for several years into postmenopausal
life. Hot flashes are sudden intense waves of heat, often accompanied
by skin flushing and perspiration followed by a chill. In some women
these hot flashes disrupt their sleep and many others report mood changes.
The frequency of hot flashes gradually declines during the postmenopausal
years. Other changes associated with perimenopause and menopause include
night sweats, fatigue, mood swings, vaginal dryness, fluctuations in
sexual desire, forgetfulness, and difficulty sleeping. Because of the
changes in the urinary tract and vagina, many women may have discomfort
or pain during sexual intercourse. Since estrogen and progesterone affect
most tissues in the body, changes can occur elsewhere in the body as
well. Some women notice changes in their skin, digestive tract, and
hair during menopause. Prolonged periods of reduced estrogen levels
may contribute to the increased risk of cardiovascular disease and osteoporosis.
Conventional Treatments
Estrogen replacement therapy
and hormone replacement therapy (HRT), which includes both estrogen
and progesterone replacement, are the common treatments for menopause.
As already discussed, the risks and benefits of hormone therapy for
menopause are controversial and the decision of whether to use hormone
replacement therapy is an individual one and an often difficult one
to make. Long term safety and efficacy has always been a concern which
was confirmed when the NHI study was stopped due to increases in breast
cancer, cardiovascular disease, stroke and blood clots in study participants.
Estrogen increases the risk of breast and endometrial cancers. For women
with an intact uterus, a progesterone and estrogen combination helps
provide protection to the uterus by keeping the endometrium from thickening
(an effect caused by estrogen), and thus helps protect against an increased
risk in endometrial cancer. However, progesterone also has several disadvantages.
Depending on the dosage schedule and woman, monthly bleeding or irregular
bleeding may occur. Other adverse effects include fluid retention, headaches,
breast tenderness, and mood changes. Progesterone may also reduce estrogen's
protective effect on the heart and cardiovascular system. Approximately
6 million women in the U.S. are presently taking estrogen plus progesterone
for a variety of reasons, including symptom relief, because their doctors
advised it, or for what they assume are long-term health benefits.
However, the WHI recommends
"women with a uterus who are currently taking estrogen plus progestin
should have a serious talk with their doctor to see if they should continue
it. If they are taking this hormone combination for short-term relief
of symptoms, it may be reasonable to continue since the benefits are
likely to outweigh the risks. Longer term use or uses for disease prevention
must be re-evaluated given the multiple adverse effects noted".
Women who have had a hysterectomy
are generally given estrogen alone, and this part of the WHI study continues
unchanged because at this point the balance of risks and benefits of
estrogen alone remains uncertain.
For those women who choose
not to take hormone replacement or in whom hormone replacement therapy
is contraindicated, effective, non-hormonal alternatives are recommended
to help counteract the symptoms of menopause.
Lifestyle Changes
There are certain lifestyle
changes that every woman can follow to maintain their health and prevent
disease. Incorporating the following may be beneficial for relieving
menopausal symptoms:
- Stop smoking.
- Exercise - incorporate
cardiovascular and muscle-strengthening exercises into your daily
routine. Exercise benefits the heart, bones and helps maintain a healthy
weight.
- Eat wisely - a balanced
diet will provide most of the nutrients and calories your body needs
to stay healthy. Calcium and vitamin D supplements are often recommended
for bone health in the prevention of osteoporosis.
- Prior to or at the onset
of menopause, ask your doctor about a bone density test, such as DEXA-scan
(dual energy x-ray absorptiometry) to see if you are at risk for osteoporosis.
- All women in their forties
and older should be screened for breast cancer with a mammogram every
year.
- Try to maintain a healthy
weight. Studies have shown that being overweight can increase your
chance of developing diabetes, high blood pressure and osteoarthritis.
Nutrition Approach
Nutrition and diet can greatly
influence menopause and its symptoms. Women in Asia experience less
menopausal symptoms as their diet contains a higher concentration of
phytoestrogens compared to women who adopt the American diet.
The North American diet is
typically deficient in essential fatty acids, which are as essential
to your diet as vitamins and minerals. This deficiency results in many
health conditions ranging from inflammation, PMS, cardiovascular disease
and menopausal symptoms. Supplementing your diet with essential fatty
acids may be beneficial for menopause.
Flaxseed -The Lignan Link
to Health
Flaxseed is nature's most
abundant source of lignans, containing a concentration more than 100
times greater than other lignan-containing foods such as grains, fruits
and vegetables. Lignans are naturally-occurring substances found in
plants and are classified as phytoestrogens, which are plant compounds
that can modulate the metabolism and use of estrogen. They work in cases
of estrogen dominance, characterized by fibroids, fibrocystic breast
disease, and PMA. They also work when the body is not producing enough
estrogen as in the case of menopause. Over the past five decades, more
than a thousand studies have examined the role of phytoestrogens in
maintaining health and in protecting against or modifying disease. The
NCCAM is currently funding research on the effectiveness of flaxseed
for treating menopausal symptoms.
Lignans can potentially reduce
menopausal symptoms, including hot flashes, sweating, and vaginal dryness
and have even been pro-posed as an alternative to hormone-replacement
therapy in post-menopausal women. In a 1998 review of alternative treatments,
the strongest evidence found for menopausal symptom relief was with
phytoestrogens.
A new study published in
September, 2002, was the first to examine the effects of natural therapies
such as flaxseed supplementation in comparison with hormone therapy.
Researchers at Universite Laval in Quebec, Canada, assigned 25 postmenopausal
women with high cholesterol to a four-month cholesterol lowering diet
followed by two months on either flaxseed supplements or hormones. After
a two-month break, the groups switched treatments. The flaxseed was
provided in bread and in ground flaxseed that was added to other food.
The study found that flaxseed supplementation and hormone therapy were
equally effective in treating some menopausal symptoms such as hot flashes.
Women are more susceptible
to developing coronary heart disease upon the onset of menopause. Phytoestrogens
are known to be effective in lowering cholesterol and serum lipoprotein
levels, which are powerful predictors of heart attacks. Thirty eight
women with high cholesterol were assigned to two treatment groups and
supplemented their diet with either flaxseed or sunflower seed for six
weeks. The subjects were provided with 38g of either treatment in the
form of breads and muffins. Significant reductions were seen in LDL
(bad) cholesterol levels and lipoprotein levels with the flaxseed treatment,
and not with the sunflower seed treatment, confirming the benefits of
flax for post-menopausal women.
Clinical research has shown
the powerful anticancer benefits of lignans due to their effect on hormone
levels. Hormone sensitive cancers such as breast, endometrium and prostate
respond favorably to supplementation with flaxseed. In one clinical
trial, 25g of flaxseed was given in the form of muffins to 25 women
diagnosed with breast cancer; 25 women received a placebo muffin. The
group that received the flaxseed muffin had slower growing tumors in
comparison to the placebo group. Overall, flaxseed has potential in
the area of prevention and treatment of specific cancers.
Flaxseed is also a source
of alpha linolenic acid, an omega-3 essential fatty acid known for its
cardiovascular benefits. Flaxseed contains approximately 40% ALA, which
is metabolised to eicosapentaenoic (EPA) and docosahexaenoic acid (DHA)
in the body. EPA-derived hormones reduce the inflammatory and vasomotor
properties associated with hot flashes. Supplementation with ALA has
many specific benefits including lowering the risk of heart disease
in women.
Gamma Linolenic Acid (GLA)
Borage oil is nature's richest
source of GLA, an omega 6 fatty acid with touted benefits for skin,
PMS, arthritis-inflammation, and cardiovascular health. In the body,
GLA is formed from linoleic acid which requires the use of a specific
enzyme known as the delta-6-desaturase (D-6D). Activity of this enzyme
is often low in most people and appears to be particularly low in those
experiencing advancing age and in women. Women with PMS and menopausal
symptoms often have low blood levels of GLA due to inactivity of the
D-6D enzyme. Supplementation with GLA has been found to relieve symptoms
of perimenopause and menopause including nighttime flushes, mastalgia,
inflammation, fluid retention, depression and irritability.
Wild Yam Extract
This herb has a long history
of use in the treatment of dysmenorrhea and menopausal symptoms. The
active components of wild yam include dioscin and diosgenin, which have
antioxidant, anti-inflammatory, and anti-spasmodic properties, which
help alleviate the effects of stress and fatigue. Wild yams also have
estrogenic properties and can be used as an estrogen replacement.
Black Cohosh Extract
This is another popular herb
used frequently for women suffering from PMS symptoms and menopausal
ailments. The actions responsible for its beneficial effects include
hormone suppressing effects, an estrogen-like action, and binding to
estrogen receptors. Clinical trials have reported a significant improvement
in hot flashes and mood swings in menopausal women treated with black
cohosh.
Soy Isoflavones
Soy has gained tremendous
popularity among women consumers due to its beneficial health properties.
Genistein and daidzein are the phytoestrogens that are present in soybeans.
As a result of their estrogenic properties, many women who consume a
high dietary intake of soy have experienced less menopausal symptoms
and have had a lower incidence of breast cancer than women who consume
lesser amounts of soy. Isoflavones are classified as phytoestrogens
and thereby exhibit similar effects to the lignans found in flaxseed.
Soy isoflavones are useful in maintaining or increasing bone density,
and decreasing the risk of cardiovascular disease by lowering blood
cholesterol and high blood pressure. Many commercial food companies
are now including soy in many different food items, thereby making soy
readily available to women.
A Smooth Transition
Natural alternatives are
quickly becoming the preferred choice over the controversial hormone
replacement therapy. Continued research is being funded to determine
the long term safety and efficacy in treating menopausal symptoms with
phytoestrogenic supplements such as flaxseed... In 2002, women now have
a myriad of options for menopausal relief, and by incorporating natural
supplements and foods such as flax, soy, dong quai, and black cohosh
into your daily diet, you will be well on your way to preventing menopausal
symptoms.
For more information, or
references for this article, please contact Karlene Karst at kkarst@bioriginal.com
About Karlene Karst
Karlene Karst is the clinical
research and education coordinator at Bioriginal Food and Science Corp.
She provides technical and regulatory advice on EFAs, as well as educational
seminars, lectures and presentations on the role of EFAs in nutrition
and health. Karlene holds a Bachelor of Science degree in Nutrition
from the University of Saskatchewan's College of Pharmacy and Nutrition.
She is also a registered dietitian and has previously worked as a clinical
dietitian.
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