|What is Menopause?
Menopause occurs when your ovaries stop making the hormones
estrogen, progesterone and testosterone they produced during
your childbearing years. This marks the end of both menstrual
bleeding and natural reproductive capability. While menopause
occurs at an average age of
|51.3, some women may experience
it as early as their thirties or as late as their sixties.
Changes in ovarian function normally begin anywhere from months
to years in advance of menopause. This period of time is called
perimenopause, and during it you may have hot flashes, irregular
periods or bleeding, or other symptoms until you reach menopause.
The medical definition of menopause is cessation of menses
for 12 months. Surgical removal of your ovaries causes menopause
to occur immediately; and other causes such as traumas, medical
conditions or chemotherapy for cancer can bring on menopause.
Symptoms of Menopause
Symptoms of menopause may include, but are not limited to, the
following: hot flashes, night sweats, vaginal dryness, painful
intercourse, decreased sexual desire, insomnia, headache, lethargy/fatigue,
irritability, anxiety, depression, heart palpitations and joint
|The Wisdom of Menopause
As a menopausal woman, you are about to enter what could be
the most positive and satisfying time of your life. Since
you can expect to live one third to one half of your life
past menopause, making the most of it and taking good care
of yourself is vital. Gone are the days when myths or silence
|about "the change of life" abounded.
Women entering menopause during the next two decades will
be the most powerful, health-conscious generation ever to
pass through this transition.
Following are brief descriptions of treatment options designed
to help you help yourself, along with suggestions about health
professionals you may wish to make a part of your own treatment
team. This is the table of contents for the rest of the article.
Click on a topic to read more.
Your Physician or Nurse Practitioner
Your physician or nurse practitioner is in an excellent position
to evaluate your general health as you enter menopause and help
you assess the risks and benefits of the various treatment options
available to you. They can prescribe hormone replacement therapy
(HRT), which involves the use of estrogen, progesterone and
possibly testosterone to treat menopausal symptoms and related
health concerns such as heart disease and osteoporosis.
Your initial exam may include a complete physical examination
(with a pelvic exam and breast exam), a PAP smear, blood tests,
mammography, review of family and medical history, assessment
of symptoms. In some cases a bone scan or endometrial biopsy may
If the results of your tests do not reveal a reason not to take
HRT (contraindication), you will have a choice to make. Whether
or not to take HRT is based on your individual set of risks and
benefits. Your physician or nurse practitioner can help you decide
what is best in your individual case. Following are the benefits,
side effects, and health concerns of HRT:
Major Health Benefits
- Prevents or treats osteoporosis
- Reduces risk of heart disease
- Withdrawal bleeding
- Headaches or nausea
- Fluid retention
- Lower abdominal bloating
- Vaginal discharge
- Estrogen allergy
- Breast tenderness/ enlargement
- Increased appetite
- Uterine or endometrial cancer
- Certain breast cancers
- Uterine fibroid tumors
- High blood pressure
- Liver and gallbladder disease
- Blood clotting
- Improves skin and muscle tone
- Eliminates hot flashes
- Decreases vaginal dryness, soreness and
pain during intercourse
- Reduces anxiety, irritability, depression,
mood swings, insomnia and fatigue
If you decide to begin HRT, there are many options for customizing
the regimen to your needs. If you still have your uterus, you
will be taking a combination of estrogen and progesterone; if
you have no uterus, you may be taking estrogen alone. Testosterone
may also be recommended for low libido (sex drive). In addition,
there are non-hormone medications that can be used to treat specific
Hormone therapy can be adjusted as to dose, brand and type. You
will generally be started on the lowest dose to protect your heart
and bones, which can be increased if symptoms persist. Types of
estrogen include oral, transdermal (the patch), vaginal cream
or injectable. Progesterone co-therapy is generally oral. Testosterone
can be given orally or by injection.
Following are some typical HRT schedules:
Read on for suggestions to complement your HRT or replace it
if you cannot or choose not to take hormones.
Acupuncture and Traditional Chinese Medicine
The practitioner of Traditional Chinese Medicine (TCM) and acupuncture
can provide you with some very effective complementary treatment
of menopausal symptoms. TCM practitioners may use acupuncture
or Chinese herbal medicine or a combination of both. The
herbal preparations contain plant sources of estrogen called phytoestrogens.
These phytoestrogens are very weak compared to drug potencies
and thus tend to have a lower potential for side effects while
effectively suppressing many common menopause symptoms.
Acupuncture involves the insertion of
fine needles (with no or very little discomfort) at precise points
of the body. This affects blood circulation, muscular tension
and other physiological processes. Beyond these changes, TCM holds
that acupuncture balances the body's life energy (chi) to promote
health and healing. The chi flows through the body in channels
called meridians which, when working in a healthy manner, distribute
energy evenly to all tissues. Negative symptoms and disease arise
when the energy flow is blocked or stopped. The goal of the TCM
practitioner is to correct any energy imbalance, allowing the
body to heal spontaneously. Modern medical research has documented
many benefits of TCM in treating such menopausal conditions as
excessive or irregular bleeding, hot flashes, vaginal and bladder
atrophy, insomnia and psychological symptoms.
A common course of treatment would begin with evaluation of your
health and symptoms followed by recommendations for the appropriate
Chinese herbal medicine and twice-weekly acupuncture treatments
in a four-week cycle.
Chiropractic adjustments can be very beneficial in treating the
headaches and generalized muscle pain (often perceived
as achiness or fatigue) which often occur around menopause. Also,
the stress of uncomfortable symptoms or lack of sleep can cause
upper shoulder tightness and neck problems. Treatment of these
symptoms with the appropriate chiropractic adjustments can prevent
chronic problems or degeneration.
Menopause occurs at a time of life when surgeries
may become necessary. Chiropractic care can help you prepare for
and recover more quickly from surgery. For example, a mastectomy
affects muscles, nerves, body mechanics and range of motion. Good
chiropractic care can speed healing, reduce pain and tightness,
and prevent long-term surgery-related problems.
Counseling or Psychotherapy
While certain forms of anxiety and depression may be more
related to the physical changes your body is undergoing, there
may be deeper issues with which you need help. Many women experience
significant problems with issues relating to employment, children
leaving home, caring for elderly parents, self-esteem and sexuality.
If you're feeling unable to cope psychologically, a counselor,
psychotherapist or women's group can be very helpful.
The physical, emotional and life changes at menopause may be
unavoidable, but some simple stress-relieving exercises performed
on a regular basis can bring you a feeling of peace and calm.
Following are a few of the many techniques you may wish to learn
more about (see reading list):
Deep abdominal breathing--induces a state of peace and relaxation
and counteracts the shallow breathing that can often be induced
by stress. Progressive relaxation--helps you discover and relax
tense, tight muscles. Affirmations and visualization--create the
mind-body connection to enhance relaxation and natural healing.
Meditation--calms the mind and relaxes the body.
Physical activity, from strenuous gardening to aerobic activity
or strength training, is one of the most beneficial things the
menopausal woman can do for herself. A regular program of physical
activity will help relieve and prevent hot flashes, vaginal and
bladder atrophy, and emotional changes or depression. It can also
benefit you with reduced risk of heart disease and osteoporosis,
easier weight control, improved appearance, decreased pain and
If you haven't already done so, resolve to move from a sedentary
lifestyle to a regular exercise program. Your physician or nurse
practitioner should check you for any undiagnosed medical problems
that could impact your appropriate type and level of physical
activity. Then consider a balanced program of weight-bearing aerobic
activity (like walking), strength training (through weights or
yoga), and flexibility. Consistent, moderate activity is best;
ideally performed daily or at least the majority of days of the
week. Now is an excellent time to make exercise an infusion of
fun into your life. You might want to try nature hiking, racewalking,
tap or belly dancing; or train for an organized walking or cycling
event. Following are more suggestions:
Physical Activity - Motivating Yourself
- Exercise at the time of day that feels most natural
- Exercise in an attractive setting or with a friend
- Listen to music while exercising
- Choose activities you enjoy
Physical Activity - Getting Started
- Build gradually by keeping workouts short at first, then increasing
your sessions by 5 to 10 minutes every week or so until you
are exercising 30 to 60 minutes
- Begin your session slowly to allow muscles to warm up and
joints to lubricate
- End your session with a cooldown followed by gentle stretching
- Wear appropriate clothing: cool, comfortable, sun protective,
- Allow enough time for your session so you don't feel stressed
- Avoid exercising when extremely ill, fatigued or stressed
Your diet is an important factor in determining your menopausal
health and comfort. The ideal menopausal diet includes foods that
are nutrient dense, high in fiber and easy to digest. Now is the
time to increase the plant part of your diet and reduce or eliminate
animal proteins. Ideal foods for menopause relief include beans
and peas (legumes), whole grains, vegetables (including green
leafies), fruits, some nuts and seeds in moderation, fish and
lean chicken. Some foods, such as soybeans, tofu, yams and many
whole grains, contain phytoestrogens beneficial to menopausal
symptoms. [Interestingly, only 10 to 15 percent of Japanese women
(whose diets contain many of the foods just mentioned) experience
menopausal symptoms, compared with 80 to 85 percent of American
women.] Nonfat dairy products are good sources of calcium, but
may not be well tolerated by all women. You'll find that smaller
servings at meals will help enhance digestion and weight control.
You should avoid caffeine-containing foods, alcohol, sugar, excessive
salt, fatty meats and saturated fats. These foods either aggravate
menopausal symptoms or add to the risk of developing the diseases
common to the postmenopausal years; diseases such as heart disease,
stroke, high blood pressure, arthritis, cancer and diabetes.
Vitamin supplements may enhance your healthful diet, but are
not a substitute for it. Vitamins that relieve menopausal symptoms
include: A, B complex, C and E*. Important minerals include magnesium,
potassium, calcium, zinc, chromium and manganese. Also important
are essential fatty acids such as flax seed oil or evening primrose
oil in treating skin, vaginal and bladder atrophy. You may find
it helpful to purchase a special vitamin/mineral formulation designed
for menopausal women.
Special Note on Calcium:
The average American woman falls short of the 1,200 mg RDA for
calcium, taking in only about 400 to 500 mg. Both the National
Osteoporosis Foundation and the National Institutes of Health
recommend that postmenopausal women take 1,500 mg daily to compensate
for calcium loss. If your diet is already rich in calcium, you
may wish to take 1,000 mg per day. These dosages are safe for
the majority of women; however, check with your physician if you
have a personal or family history of kidney disease.
Not all calcium supplements are equally well absorbed. An acidified
form of calcium called calcium citrate is best, followed by the
less expensive calcium carbonate. Calcium lactate and calcium
gluconate are quite poorly absorbed. Take calcium pills with meals
and in divided doses to further enhance absorption.
* For treatment of vaginal atrophy Vitamin E can also be applied
directly into the vaginal canal, either in suppository form or
by breaking open a Vitamin E capsule.