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September 30 2022
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Menopause seems to be a dreaded question mark. As with all major life-cycle events, there are no guarantees as to how and when menopause will affect a woman. It could be induced early by way of procedures that involve the removal of female hormone-producing organs, or begin early because of genetic predisposition. Classically defined as one year with no full menstrual cycles, menopause involves the waning of estrogen, in particular, and comes with a variety of unwanted side effects. Will there be hot flashes? Loss of libido? General irritability? Brain fog or other cognitive impairment? Any number of symptoms can be associated with decreases in estrogen and progesterone.
Estrogen is primarily produced in three forms (estrone or E1, estradiol or E2, and estriol or E3) in ovaries, corpus luteum and placenta, and in smaller amounts in the liver, heart, skin and brain. Prior to the onset of menopause, E2 is the predominant form of estrogen. Post-menopause, E1 is more important, and during pregnancy, E3 is produced in larger quantities within the placenta. Testing for levels of these specific forms of estrogen helps determine the cause of various symptoms.
While there is no treatment for menopause, per se, there are a number of suggested lifestyle changes to consider. In addition to contrasting opinions among conventional and alternative medicine practitioners, each woman is unique and experiences therapies differently. Dietary changes, exercise, self-care for stress reduction, hormone replacement therapy (HRT), botanicals, and nutraceuticals are all options. To further complicate these suggestions, pre-existing conditions, such as breast cancer, may also influence therapy options so it is always
advised to work with a trusted clinician. The most prevalent health concerns of menopause include hot flashes, sleep disturbance, bone health, and emotional well-being.
Body Thermostat on High
Like someone cranked the thermostat dial to high, hot flashes can come intensely and without warning. A vasomotor reaction to who-knows-what, they cause flushing of the face, instantaneous sweat and total-body heat. Women tend to suffer privately as no one is co-experiencing them. Most deal with this dreaded inconvenience with layered clothing and getting used to fanning themselves. But what happens if they become excessive and interfere with one’s daily life?
Regular exercise, a healthy diet, particularly higher in fiber, and moderate weight loss can help. Further, some botanicals such as black cohosh and chaste tree berry have been found to have some positive effect on hot flash occurrence. Two randomized trials found black cohosh improved menopause symptoms including hot flashes. One study conducted on 84 early post-menopausal participants evaluated their vasomotor response using the Green climacteric scale (GCS), which also evaluates psychiatric, physical and sexual symptoms. Half of the subjects received 6.5 mg of dried extract of Black cohosh roots daily, while the other half (the control) received a placebo. The GCS total score, and the severity of vasomotor symptoms and number of hot flashes, in the Black cohosh group was significantly lower at both week 4 and week 8 relative to the control group.
Sleep, luxurious sleep! We don’t prioritize it quite as we should with our stimulating, high stress modern lives. Sleep, however, is critical to physiological functions ranging from mood to weight management, as well as learning and pain perception. Since most hot flashes experienced at night occur earlier in the sleep process, multiple awakenings may inhibit later-phase sleep, which includes the coveted, restorative REM. Severe hot flashes trigger insomnia, which may result in chronic pain, depression and overall poor health.
In order to prevent this vicious cycle, good sleep hygiene (getting to bed in time for a solid eight hours, avoiding caffeine and alcohol, and keeping the blue lights of electronics off for at least an hour before bed) is recommended. Additionally, a cup of herbal tea or supplements with the herb chaste tree berry (Vitex agnus-castus) can help. A 12-month study looking at the safety and efficacy of a botanical blend that included chaste tree berry, magnolia extracts, soy isoflavones and lactobacilli, for the treatment of menopause symptoms, found study participants had a significant decrease in hot flash frequency and improvement in overall sleep quality with no reported adverse effects.
Not So Good Mood
There is a stereotype that women of the “age of transition” can become moody, and some data shows that the physiological changes undergone during menopause can be a culprit. What’s perhaps not well-known is that women with a history of depression are at a much higher risk for developing more severe emotional disturbances, such as major depressive disorder, when approaching menopause. One review suggests that routine screening for depression helps identify this and can help the individual take action before the condition takes over. Once again, diet, exercise and managing environmental triggers work together to balance and potentially ameliorate depressive symptoms. A recent article in the Wall Street Journal describes how a Mediterranean-style diet -- high in fruits and veggies, nuts, seeds, fish and smaller amounts of protein from animals -- may help stave off mood disorders.
A Bone to Pick
As women age, their bone health may also be at risk. For years, calcium supplementation has been recommended. While this topic is far more complex that recommending calcium chews, it is important to note the relevance of bone loss to menopause. Estrogen is an important compound that influences bone metabolism. A deficiency in estrogen increases bone-remodeling and bone resorption, which contributes to the risk of osteoporosis. Therefore, it is the decreasing estrogen that explains the increased risk in older women, but the answer to mitigating the risk is more complicated.
Following guidelines for regular bone density testing and applicable nutrition and lifestyle to promote good bone health is paramount. Regular weight-bearing and resistance training exercises and a well-balanced diet rich in calcium, vitamin K, magnesium are always recommended. Supplementation with vitamin D, isoflavones derived from soy and red clover, berberine and hops may be considered with clinical guidance.
Menopause can be complex and is personal for all women managing diminishing amounts of hormones. As challenging as it can be, it is also an opportunity to cherish the individuality of each woman going through this time of life.
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