Menopause

Menopause marks the end of a woman's reproductive years. It is a normal biological event (except with surgery). Women begin menopause at the average age of 51. Although women now live longer the age at which menopause begins has not changed. This means most women will live a third of their lives after menopause.

Signs and Symptoms

• Menstrual bleeding slows and then stops; process takes about four years
• Hot flashes—flushing of face and upper trunk; may occur with heart palpitations dizziness headaches
• Night sweats—depression and irritability may result from insomnia
• Cold hands and feet
• Vaginal symptoms—dryness bleeding after intercourse itching
• More frequent urination burning nighttime urination
• Depression irritability tension; usually occurs with sleep disturbances
• Facial hair growth and wrinkles
• Osteoporosis—bone breaks become more likely
• Coronary heart disease (CHD)—twice as many women die from CHD than cancer

What Causes It?

Lower estrogen and progesterone production--as the result of fewer functioning follicles (the cell structure that houses the eggs)--leads to the end of menstruation. There may be a genetic link for the age of onset. Smoking lowers the age at which menopause begins.

What to Expect at Your Provider's Office

Your health care provider will give you an examination that includes a Pap smear and will describe the benefits and risks of different treatments.

Treatment Options

Treatment Plan

Your health care provider will discuss with you the various drugs available for the symptoms of menopause. There are potentially serious side effects from these drugs. Careful consideration of alternatives is justified.

Drug Therapies

Prescription

• Estrogen helps hot flashes and vaginal symptoms. It can slow osteoporotic bone loss and fractures. It may prevent CHD and Alzheimer's. Estrogen increases your risk of getting breast cancer gallbladder disease and blood clotting. Side effects include bloating nausea adult-onset asthma and breast tenderness.
• Estradiol is a type of estrogen. It brings the estrogen directly into your blood stream. Estradiol is available in a patch or gel.
• Vaginal estrogen creams help vaginal and urinary symptoms. It takes four to six weeks for the cream to work. There is a new intravaginal ring that slowly releases estrogen.
• Progesterone prevents uterine cancer that can occur with estrogen therapy.
• Methyltestosterone increases libido and may decrease osteoporosis of the spine. Facial hair growth is a side effect.
• Alendronate is equally as effective as estrogen in preventing osteoporosis.
• Lipid-lowering drugs and aspirin are alternate treatments for CHD.

Over the Counter

N/A

Complementary and Alternative Therapies

Alternative medicine has much to offer for improving cardiovascular health and preventing osteoporosis. Relaxation techniques stress management yoga and meditation can help with perimenopausal symptoms. Exercise increases endorphin release which helps relieve pain and elevates mood. Walking swimming and biking are less stressful on the joints.

Nutrition

• Soy (25 to 50 mg soy a day) contains soy isoflavones (phytoestrogens) which may relieve hot flashes and vaginal symptoms and offer increased protection from osteoporosis and breast cancer.
• Vitamin E (400 to 1 600 IU a day) can balance vasomotor instability decrease hot flashes and is cardioprotective. High doses are not recommended for women with high blood pressure.
• Take calcium/magnesium (1 000/500 mg a day for women taking estrogen and 1 500/750 mg a day for those who are not) with meals. Citrate or citramate forms may be the most absorbable forms.
• Avoiding smoking alcohol caffeine and spicy foods may help decrease hot flashes.
• A combination of vitamin C (1 200 mg) hesperidin (900 mg) and hesperidin methyl chalcone (900 mg) may relieve hot flashes.
• Gamma-oryzanol (from rice bran oil) 300 mg per day gives partial or total relief of hot flashes in over 80 percent of users.

Herbs

Herbs may be used as dried extracts (capsules powders teas) glycerites (glycerine extracts) or tinctures (alcohol extracts). Teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers; 10 to 20 minutes for roots. Drink 2 to 4 cups per day.

• Black cohosh (Cimicifuga racemosa) relieves vasomotor symptoms and depression; Remifemin is the most tested extract of black cohosh. Long-term use is safe; 2 mg a day
• Chaste tree (Vitex agnes-castus) for irregular menstrual cycles; may take up to six months for full therapeutic effect
• Angelica (Angelica archangelica) relieves vasomotor symptoms.
• Licorice (Glycyrrhiza glabra) an estrogen-balancing herb especially for chronic stress; do not use if you have high blood pressure; 250 mg three times a day 30 to 60 drops tincture three times a day or 1 cup of tea three times a day
• Ginkgo (Ginkgo biloba) improves circulation to cold hands and feet; also used to treat depression; may take up to 12 weeks for full effect; 120 mg two to three times a day

Homeopathy

Some of the most common remedies used are listed below. Usually the dose is 12X to 30C every one to four hours until your symptoms get better.

• Mulimen—German combination remedy (chasteberry black cohosh St. John's wort cuttlefish ink) for hot flashes
• Homeopathic estrogen—by prescription only
• Ferrum phosphoricum graphites lycopodium—for symptoms occurring during sexual intercourse
• Amyl nitrosum lachesis sulphur—for hot flashes

Physical Medicine

Kegel exercises increase pelvic muscle tone helping to prevent incontinence and bladder or uterine prolapse.

Acupuncture

Acupuncture enhances endorphin release and stimulates kidney function. It may also help to balance hormones and relieve vasomotor symptoms.

Massage

Massage increases circulation. Use water-soluble nonestrogen lubricants vegetable oil or vitamin E oil for vaginal atrophy.

Supporting Research

Bartram T. Encyclopedia of Herbal Medicine. Dorset England: Grace Publishers; 1995:291–292.

Blumenthal M ed. The Complete German Commission E Monographs. Boston Mass: Integrative Medicine Communications; 1998:108 466.

Devine A Dick IM Heal SJ et al. A 4-year follow-up study of the effects of calcium supplementation on bone density in elderly postmenopausal women. Osteoporosis Int. 1997;7:23–28.

Gruenwald J Brendler T Jaenicke C et al eds. PDR for Herbal Medicines. Montvale NJ: Medical Economics Company; 1998:647–648 871–872.

Kistner RW ed. Kistner's Gynecology: Principles and Practice. 6th ed. St. Louis Mo: Mosby-Year Book; 1995.

Murray MT. The Healing Power of Herbs: The Enlightened Person's Guide to the Wonders of Medicinal Plants. Rocklin Calif: Prima Publishing; 1995:163–164.

Murray MT Pizzorno JE. Encyclopedia of Natural Medicine. Rocklin Calif: Prima Publishing; 1998.

Thys-Jacobs S Starkey P Bernstein D Tian J. Calcium carbonate and the premenstrual syndrome: effects on premenstrual and menstrual symptoms. Premenstrual Syndrome Study Group. Am J Obstet Gynecol. 1998;179:444–452.

Villa ML Packer E Cheema M et al. Effects of aluminum hydroxide on the parathyroid-vitamin D axis of postmenopausal women. J Clin Endocrinol Metab. 1991;73:1256–1261.

Vorberg G. Treatment of menopause symptoms—Successful hormone-free therapy with Remifemin®. ZFA. 1984;60:626–629.

Weiss RF. Herbal Medicines. Beaconsfield England: Beaconsfield Publishers; 1998:317–319.

Copyright © 2000 Integrative Medicine Communications

The publisher does not accept any responsibility for the accuracy of the information or the consequences arising from the application use or misuse of any of the information contained herein including any injury and/or damage to any person or property as a matter of product liability negligence or otherwise. No warranty expressed or implied is made in regard to the contents of this material. No claims or endorsements are made for any drugs or compounds currently marketed or in investigative use. This material is not intended as a guide to self-medication. The reader is advised to discuss the information provided here with a doctor pharmacist nurse or other authorized healthcare practitioner and to check product information (including package inserts) regarding dosage precautions warnings interactions and contraindications before administering any drug herb or supplement discussed herein.