Menopause

Menopause is the time when periods stop permanently either due to a gradual natural processes or abruptly when induced by artificial means (surgery or radiation).

Prior to the final menstrual period there is a transitional time, perimenopause, lasting up to eight years. During this time most women begin missing periods and their menstrual cycles lengthen. A woman is usually considered postmenopausal 12 months after her last period. The entire menopausal process can take up to thirteen years. Menopausal signs and symptoms are due to the body's inability to respond to a decrease in oestrogen, progesterone and possibly androgens such as testosterone and dehydroepiandrosterone (DHEA). Other hormonal changes include an increase in follicle stimulating hormone (FSH) and luteinizing hormone (LH).

Signs and symptoms of the menopause can include any of the following:

• irregular and/or heavy periods
• breast tenderness and swelling
• dry vagina
• low libido
• hot flushes and night sweats
• anxiety and agitation
• depression
• lethargy
• mood swings
• behaviour or feelings, which are out of character
• impaired memory, concentration and vagueness
• bloating
• headaches/migraine
• heart palpitations
• itchy skin
• insomnia
• thinning and ageing of the skin and/or hair
• weight gain

In addition to the fluctuations in hormone levels, other possible causes of menopausal discomfort may include adrenal exhaustion and impaired liver function. If you think you may be experiencing
the menopause, a blood test can be arranged for you, which will tell you what your hormone levels are.

The Orthodox Approach

Hormone replacement therapy (HRT) is a comprehensive treatment for the symptoms associated with the menopause, regarded as deficiency disorder by conventional medicine. H.R.T. replaces some of the hormones that your body is no longer producing with a combination of oestrogen and progestogen or oestrogen alone. It can be taken in the form of pills, as a cream applied to the skin, as a patch, or it can be implanted. There are dozens of different preparations now available; some promote a monthly bleed, others do not.

H.R.T. can be taken as soon as symptoms of the menopause, such as hot flushes and vaginal dryness, appear and can, in theory, be take indefinitely. But H.R.T. is still considered to be controversial and it is not recommended that women take it for any length of time. Some undoubtedly find it a convenient “one stop” solution to the problem of hot flushes, night sweat, and vaginal dryness. Staunch advocates regard it as an “elixir of youth”, claiming that it improves the appearance of skin and hair and gives a sense of well-being. But many women complain of side-effects such as weight gain, hair loss, headaches, tender breasts and water retention. Recent research also indicates an increased risk of breast cancer. On the other hand H.R.T., helps protect against osteoporosis and the post-menopausal risks of heart attacks and strokes.

Anyone who has had breast or womb cancer or fibroids is not advised to take H.R.T.

Quite apart from H.R.T. there are conventional treatments available for specific problems. Your doctor may prescribe a drug containing clonidine hydrochloride for hot flushes and there are a number of gels and pessaries containing oestrogen to combat vaginal dryness. A vaginal lubricant may also help.

The Hale Approach

Menopause is a natural progression, not a disease, and therefore does not require treatment. If the symptoms are unpleasant, complementary therapies should be tried first, with orthodox measures such as H.R.T. used only as a last resort.

Menopause is one of the most important “passages” a woman has to face in her life. Particularly in the West, it can be a time of great unease, discomfort, and uncertainty, or a time to value and respect the past and go forward positively with a body which has adjusted to this new state and with a mental/emotional outlook which is looking forward to experiencing this new cycle in a woman’s life.

Many people view the menopause as starting with hot flushes and changes in the pattern or heaviness of periods. They are not always aware of the pre-menopausal state which starts about five years before the onset of the “real thing”.

As most menopause starts around the age of 50, the average time for pre-menopause is 45. At this time you could start having mood swings and other symptoms without realizing that you are in pre-menopausal state. The Hale Clinic would advise women from about 45 onwards to have yearly hormonal tests to ascertain whether hormonal changes have already started. If this is the case, the treatments used for the “menopause proper” will also be great assistance during the pre-menopausal years.

In addition, good nutrition, exercise and massage to promote good circulation and reduce stress levels can help prepare the body and mind so that the “the passage” becomes much easier.

The closest complementary treatment to H.R.T. would be a combination of herbal remedies which contain phyto-estrols, which mimic the role of oestrogen, thereby preventing the menopausal symptoms (although periods will stop eventually).

Trichology and Oxypeel treatments can help any external effects on the hair and skin caused by the menopause.

Osteoporosis screening is also recommended to assess bone density; advice on future courses of action would be given on the basis of the results.

Finally, because the menopause can be such an important time of change in a woman’s life, the Hale Clinic would highly recommend counselling or psychotherapy to assist a woman in integrating this new cycle into her life, and from there approaching the future with an awareness of the many opportunities it can bring.

Herbal Medicine

Herbal Medicine provides a safe and gentle alternative to HRT, without the side-effects.

What is the aim of herbal treatment during the menopause?

Support of the adrenal glands: As the ovaries slow down, the adrenals are capable of producing oestrogen

Support of the nervous system to alleviate anxiety, depression and insomnia

Reduce the number and severity of hot flushes and night sweats

Increase vitality, where the patient is feeling tired or exhausted

Boost liver function: Adequate metabolism of hormones by the liver helps to ease many menopausal symptoms

Every woman experiences menopause in a slightly different way to others so a one size fits all over the counter remedy does not always get the best results. A Herbal Medicine prescription is tailored to meet each patient’s unique needs and can be adjusted to give more support as oestrogen levels decline. Dietary guidance is also given. Patients find that this approach gets the best results and supports them through the menopause until such time as their body has adjusted to the lower oestogen levels. This natural approach to the menopause is becoming increasingly popular and is a safe, gentle way forward.

Herbal support for women planning to stop taking HRT

The majority of women begin taking HRT, when uncomfortable or debilitating menopausal symptoms disrupt their life. After the 2002 findings regarding the undesirable side effects of HRT, it is now recommended that for most women HRT only be used in the short term. This recommendation is questionable as it only briefly delays menopausal symptoms. The effect of the initial publications of the WHI, and also the Million Women Study (MWS), resulted in a decline in HRT use of around 50% in the UK. For those who have chosen to stop HRT, the dose should be gradually reduced in order to minimise the effects of hormone withdrawal.  Ideally, herbal treatment will begin prior to any change in the dosage of HRT. This can be done with the co-operation of your doctor. In fact, many GPs are now referring perimenopausal patients to Herbal Medicine.

Acupuncture

The changes of the menopause affect the functions of the liver and kidneys which regulate the hormonal balance in the body. In Chinese medicine the kidney is ‘water’ and the liver is ‘fire’ or ‘wood’”.  When these get out of balance the water function becomes sluggish and the heat, the liver function, is too dominant, resulting in the irritability, anxiety, hot flushes, water retention, and other symptoms of hormonal imbalance women experience at menopause.

Acupuncture aims to rebalance the body by stimulating the kidney function, increasing the energy flowing through this pathway. It may be used in conjunction with Chinese herbs, which will be prescribed for use at home.

Psychotherapy

The hormonal changes of the menopause are frequently associated with a number of psychological problems such as depression, loss of confidence and self-esteem or feelings of acute self-doubt and eating problems. Psychotherapists believe that hormonal changes are part of the cause of these problems, but many are due at least in part to the stage of life. Women may be particularly vulnerable when their children leave home, an event which often coincides with the menopause.

Talking to a psychotherapist should help you understand your reactions and feelings through examining your past; you can then start challenging your behaviour. Developing new attitudes and becoming more conscious of the way you react to stressful situations can help overcome many of the emotional difficulties associated with the menopause.

Homeopathy

Homeopathic treatment for the menopause aims to help your body adapt to change. Change is inevitable, but it needn’t be disruptive. Advice should be sought as soon as periods become irregular so that the effect of the inevitable hormonal changes – hot flushes, irritability and sleep disturbance – are managed and contained. Treatment starts with an assessment of the individual’s overall health and personality and may include a blood test to check hormonal levels.

Septia, Belladonna and Agnus castus are among the natural remedies prescribed to combat menopausal symptoms. Calc carb, Gelsemium and Graphites may be prescribed for hot flushes. There are also treatments to counteract the side-effects of H.R.T. and to help women who want to stop taking it without suffering the return of menopausal symptoms.

Nutrition and Naturopathy

Menopausal problems can be exacerbated by poor eating habits developed over a long period. Re-establishing a healthy diet with a wide range of fresh foods is of prime importance. Leafy greens, soya prod X-Requested-With: XMLHttpReque a major part in your diet; intake of red meat and caffeine should be reduced. In general, guard against having too much protein in your diet, since this is believed to rob the body of calcium and other essential nutrients.

Examining not just what you eat but the way you eat is crucial. Taking smaller meals throughout the day rather than leaving long gaps between meals maintains blood sugar levels and helps fend off nervousness and low energy.

Tips

Spicy foods, hot drinks and alcohol can all trigger hot flushes.

A Vitamin E capsule inserted into the vagina each day is an effective treatment for dryness.

Avoid powerfully scented soaps or vaginal sprays: these may irritate the vaginal area, which his often more sensitive at menopause.

Weight-bearing exercise such as brisk walking will build up bone density and improve circulation, which is of benefit during pre-menopause and menopause.

Supportive Treatments

Maya Abdominal Massage: A non-invasive massage technique that specialises in treating gynaecological and digestive conditions. It improves organ function by relieving congestion, enhancing blood supply; increasing lymphatic drainage and aiding nerve supply to the pelvic and reproductive organs.

Remedial Yoga: Learning to relax and keep the body supple are important in restoring and maintaining an equable and confident approach to life.

Healing: Feelings of fatigue and lethargy can be helped by healing, which works to put energy back into the body.

Hypnosis: Hypnosis can reassure and empower the unconscious mind to intervene, balance and harmonize the body’s natural rhythms.

Chi Kung: Exercises can help counteract specific symptoms of hormone imbalance and make you feel more in control.

Trichology: There a number of scalp therapies and treatments for hair loss due to hormonal changes. These aim to improve circulation and stimulate follicular cell activity.