A Holistic Guide to Menopause

What is Menopause?

Menopause is derived from the Greek words meno (monthly) and pausis (to stop) . Essentially it is caused by your ovaries no longer making estrogen and progeserone, two hormones responsible for fertility and a vast array of other functions in the body. Small amounts are still made in other areas of the body, such as the adrenal glands and the liver and even fat cells.

You are officially in menopause if you have had no menstrual periods for 12 months. The period prior to this is known as Perimnopause. At this stage, estrogen levels increase and progesterone levels decrease. This can result in heavier and longer menstrual flow, mood changes and agitation due to estrogen dominance.

Most women experience Menopause between the age of 48 to 55 years. But it can also stem from surgery, treatment of a disease, or an illness. In these cases it can be called induced menopause, surgical menopause, or primary ovarian insufficiency, depending on the cause.

Symptoms

The symptoms of menopause are varied and no two women are the same. Some women transition from regular menstrual flow to the cessation of their periods with little or no challenging symptoms. However, if you're reading this, you're probably experiencing symptoms which are disruptive to your quality of life.

The most commons signs and sypmtoms of menopause are Hot flashes . Hot flashes are a rapid and exaggerated heat dissipation response, consisting of profuse sweating, peripheral vasodilation, and feelings of intense, internal heat. This occurs because of the decrease in estrogen production and the increase in noradrenaline output in the brain, ultimately leading to the narrowing of the thermoneutral zone located in the hypothalamus. This renders the body more sensitive to very slight changes in core body temperature.

Other symptoms can include Insomnia, memory problems, low mood , no libido, weight gain and hair, skin and nail issues. In addition, postmenopausal women have an increased risk for bone loss, cardiovascular disease and cognitive impairment.

Treatments

There are a number of ways to alleviate Menopausal Symptoms. Hormone Replacement Therapy (HRT) is available , which replaces your Estrogen and Progesterone. Many women find effective relief. However there are precautions that need to be noted with them, such as increases in risk of stroke, thromboembolisms, and increase in breast and ovarian cancer risk. Contact a qualified healthcare practitioner on your options regarding HRT.

Tackling Stress

As we previously mentioned, the HPA (Hypothalamic -Pituitry-Adrenal) Axis is one of the systems responsible for Estrogen production after Menopause. It is also responsible for the body's response to stress. If you lead a stressful lifestyle and placed a great deal of pressure on this system, then it is unlikely that it can also cope well with the extra pressures that come with Menopause. It is therefore a top priority to reduce stress as much as possible.

“The greatest weapon against stress is our ability to choose one thought over another” - Williams James

Creating calm despite what is going around us is a powerful life skill. Meditation and yoga are two breath-focussed practices that can support the body to transition from a dominant sympathetic nervous system (fight or flight) to the calm parasympathetic nervous system (rest and repair). Diaphragmatic breathing (moving your tummy in and out as you breathe) reduces stress hormone output significantly and takes the pressure off the adrenal glands.

The simple image above shows that Pregnenolone is the precursor to Reproductive hormones as well as cortisol. High stress situations will divert resources away and towards more Cortisol production, leading to an imbalance in sex hormones.

Aromatherapy is another great way of reducing stress and promote feelings of well-being. Oils like Lavender, Lemon, Bergamot, Sandalwood, Cedarwood, Frankinsense and Chamomile are all great choices.

Accupuncture can also be effective for hot flashes and stress reduction. The mechanism of action is thought to be through changing the levels of beta-endorphins and other neurotransmitters potentially affecting the thermoregulatory centre. Accupuncture for hot flashes is best given weekly or biweekly. You generally notice improvement in intensity before a reduction in frequency and often need two to three session to have an effect.

Diet

Be careful not to consume excess coffee as it can place an extra load on your HPA Axis. Also, alcohol puts greater pressure on the liver and will disrupt hormone metabolism. Generally it is recommended to avoid processed carbohydrates and sugars.

You calcium needs will increase as you go through menopause as as the loss of estrogen will speed up bone loss. Aim for at least 1,200mg of calcium daily. Consider a combination of calcium rich foods, such as milk, yoghurt and calcium supplements. 

Soy contains isoflavones which help modulate the production of estrogen and promote binding into E2 receptors, which convert into the more beneficial, anti-inflammatory type.

Healthy fats are very important to make hormones, decrease inflammation and improve skin health. Good sources include oily fish, flaxseeds, hemp seeds, chia seeds, walnuts, pecans, evening primrose oil, blackcurrant oil or borage oil.

Avocados and macadamia nuts (and their oils) are also a great choice. They are also very satiating and can help to regulate blood glucose levels.

Medicinal Herbs

Herbal formulas can act synergistically to ease stress, balance hormone levels, support the liver and decrease inflammation. Each herb can help stabilize a different symptom and need to be taken with the advice of a qualified natural health professional. Examples of herbs used for menopause include Rehmania, Korean Ginseng, Sage, St. Johns Wort and Withania. Other helpful herbs for sleep and relaxation include Kava, Valerian, Zizyphus and Passionflower. Some are great for supporting the liver, such as Turmeric, Milk Thistle and Broccolli Sprout extract. Ones for Libido can include Tribulus and Maca. Always seek advice from a qualified practitioner such as a Naturopath or Medical Herbalist who can make a specific formula to suit your needs and understands your symptoms. They also have access to higher quality and more effective formulations than simple OTC supplements.

Vitamins and Minerals

Nutrients such as magnesium, calcium and vitamin D are often used to help manage hot flushes, sleep and mood. But, most importantly, they can help to preserve bone density. Zinc is also hugely important to help synthesize sex hormones and regulate cholesterol metabolism, which can often increase as hormonal production declines and the liver has more to deal with. Given these symptoms, though, it would be wise to see your GP and have some blood tests, particularly for thyroid function and iron.

Endocrine Disrupters

Endocrine disrupting chemicals (EDCs) and potential EDCs are mostly man-made, found in various materials such as pesticides, metals, additives or contaminants in food, and personal care products.

Endocrine disruptors are interesting chemicals because they can mimic hormones. In doing so, they can bind hormone receptors and (a) create a powerful response, even more powerful than the original hormone; (b) create a less powerful response than the original hormone; or (c) create a totally different response than the original hormone. 

Examples of EDCs which can affect reproductive hormones include Pesticides (Glyphosate etc), BPA (found in plastics), UV filters (found in sunscreens & Cosmetics), Parabens (Found in wide range of personal care products including deoderants).While some of these products are very hard to avoid, there are many products you can switch to using which don't contain EDCs. Natural personal care products and skincare are a great example. It is also another reason to support your liver. Brocolli Sprout extract is particularly effective.

Osteoporosis

Osteoporosis is a metabolic bone disease that results in deterioration of the matrix of the bone resulting in lower bone mass and increased risk of fractures. Nearly half of the women over 65 will experience an osteoporosis related fracture in their lifetime. These fractures (mostly of the spine, hip or forearm) dramatically increase the rate of mortality and need for long-term care. One of the most critical factors in the prevention of osteoporosis is reaching peak bone mass prior to menopause. Most women do not accomplish this for a number of reasons, among them are poor diet and lack of weight bearing exercises. Several reports have shown that something as simple as the consumption of phosphoric acid in soft drinks reduces bone mineralization in postmenopausal women. The very low phytoestrogen (I.e Soy) intake in western diets may also play a role in this as well. Estrogen plays an important role in maintaining bone mass in women by suppressing the breaking down of bone tissue by Osteoclasts. As menopause is a low estrogen state, the balance is shifted toward the osteoclast (resorption) and away from osteoblast (bone building) activities.

Adequate intakes of calcium, magnesium, and trace minerals such as boron, silica, selenium, manganese and molybdenum are all important to proper bone metabolism. The hormone-like activities of vitamin D and K are also vital components in the maintenance of bone mass. Doing a bone density scan is a great way to know if you are at risk of Osteoporosis.

References:

Rakel, D. Integrative Medicine 4th Ed.

Menopause: Biology and Pathobiology. Edited by Rogerio A. Lobo, Jennifer Kelsey and Robert Marcus. 2000.Acedemic Press San Diego, CA •

Women’s Encyclopedia of Natural Medicine. Tori Hudson.1999 Keats Publishing Los Angelos, CA.

Women,Hormones & the Menstrual Cycle- Herbal and Medical Solutions from Adolescence to Menopause. Ruth Trickey. 1998 Allen & Unwin St. Leanards NSW,Australia.

The Complete German Commission E Monographs. Blumenthal 1998 American Botanical Council Austin,Texas

http://www.pointinstitute.org/wp-content/uploads/2012/10/standard_v_4.1_menopause.pdf

http://www.who.int/ceh/risks/cehemerging2/en