Women's Issues
Menopause
by Carolyn Ross, MD

		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 pain. more symptoms

		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.

Treatment Options
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 be recommended.

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:

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 menopausal symptoms.

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 Care

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.

Stress Reduction

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

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 better sleep.

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, absorbent
• Allow enough time for your session so you don't feel stressed or rushed
• Avoid exercising when extremely ill, fatigued or stressed

Nutrition

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.