Managing Menopause Naturally: Before, During, and Forever

This book is designed to help women manage menopause naturally, beginning with the transition from regular monthly menstruation and its accompanying possibility of pregnancy to a new freedom called menopause. By the year 2015, 50 percent of the women in the United States will be menopausal, and three-quarters of these women will have symptoms. Contrary to the current interests and practices of our medical establishment, however, menopause is not a disease, and it does not usually require pharmaceutical medication. (Pregnancy and childbirth aren’t diseases either, for that matter.) Women are supposed to stop menstruating at a certain age. When and how we originally go from girl to woman and have our first period (menarche) is determined by many factors (hormonal, dietary, emotional, and environmental), and there are just as many factors that contribute to menopause at the cessation of menstruation and the end of our fertile years. Menopause is a gift that allows us to live many more years without periods, without the specter of an unwanted pregnancy, and without the potential roller coaster of premenstrual moodiness. It technically begins twelve months to the day after the last menstrual period, and may be rocky at times, but this book is intended as a road map to help you navigate through it smoothly and emerge radiantly healthy.

Part One has ten chapters detailing the top ten complaints of hormonal shifting, including breast tenderness, bone loss, and hot flashes. Chapter 1 explains which hormones are involved in menstruation and their role in menopause. Each chapter in Part One has a final summary for quick reference. Part Two introduces and explains some of the exceptional tools and techniques you can use to create a natural, wholesome transition to menopause. Part Three describes the major hormonal control systems of the body—the adrenals, ovaries, and thyroid gland—so you will understand what is really going on in your body during this transition. Part Four is an overview of how to stay healthy and happy beyond menopause, with chapters on maintaining a functional immune system, preventing heart disease, and the connection between cancer and diet.

My bias as a naturopathic doctor is to work with what nature offers: fresh air, pure water, organic food, and most of all, the incredible blend of what makes up a person. The physical machine, the realm of feelings and emotions, and the complexity of the intellect are all equally important players in our health and well-being. My perspective, and my goal for the patients under my care, is not merely to be rid of illness, but to achieve optimum health and well-being. Remember, hormonal transition is normal. You are not sick, and you probably don’t need drugs or to go to the hospital.

It is tricky to get an unbiased opinion about medical approaches to menopause when the information is coming from doctors, and even more so from pharmaceutical company representatives, who have a financial interest in your dependence upon their products and services. The purpose of this book is to open your mind to the possibility of natural self-care as you go through menopause or any other life transition. Ultimately, a commitment to healthy choices in diet, relationships, and daily activities is what creates a permanent and solid foundation for well-being.

I would like to briefly address a few menopause myths.

✗  In the old days, women didn’t live much beyond menopause, but modern women live much longer so their estrogen must be replaced. One hundred years ago, women did die sooner, but these deaths were mostly related to childbirth. Either the infant girl died, or the young mother giving birth died because of blood loss or infection. Even hundreds of years ago, women who survived infancy and childbirth often lived to old age. Further, women continue to secrete estrogen from their adrenal glands and fat cells their entire lives. Menopausal and perimenopausal women have a naturally appropriate amount of estrogen production for these phases of their lives.

✗  Menopause causes arthritis, heart disease, osteoporosis, and all sorts of other chronic diseases. Actually, unhealthy aging causes these problems. Men typically acquire heart disease earlier than women and they are not exempt from osteoporosis (bone loss). I sincerely hope this book will help you gain a great deal of practical information about healthy aging.

✗  Menopause turns women into raging terrors (I’m avoiding the B word here). Actually, younger women are more likely to fly into rages and get moody, for two reasons. First, they have a lot more hormonal activity than a menopausal woman. And second, just like good wine, women tend to mellow with age.

✗  Menopause should be treated with standard hormones. This is what the drug companies would like you to believe. The truth is, there is no one-size-fits-all solution to hormone replacement, even assuming it is needed at all. Standard prescription hormones have been proven to be harmful. Luckily, there are safer alternatives available in plant based and bioidentical hormones, which are explained in Chapter 11, the opening chapter of Part Two.

The primary message of this book is that menopause is a transition—it is not an illness. The transition may be long and gradual or it may be abrupt. Each woman is unique and will experience her passage differently. A number of general concepts that hold true are presented in these pages. A highly important one is to stay committed to excellent health and focused on cultivating a deep sense of joy. We’re only sure we’ve got this life—we might as well make it stellar!

The orchestration of menstruation is as complex as any symphony. Our monthly periods are a result of hormonal changes, glandular secretions, and a system of temporary arteries within the uterine lining. For convenience, the first day of bleeding is considered to be day one of the menstrual cycle, which is generally twenty-nine days in length. The first half of the menstrual cycle is called the follicular phase, because follicles, which protect the clusters of maturing eggs within the ovaries, begin to ripen. This follicular development is responding to a brain secretion called FSH (follicular stimulating hormone) and is initially independent of other hormonal influence. Levels of the hormone estrogen are relatively low at this point, but the rising levels of FSH stimulate both the FSH and LH (luteinizing hormone) receptors in the follicles. The activated FSH and LH receptors, in turn, stimulate production of estrogen hormone in the follicles. LH is the hormone that provokes ovulation (the release of egg(s) from the ovary).

What Estrogen Does

The secretion of estrogen in the follicles causes a gradual increase in the production of cervical mucus that peaks when the monthly estrogen secretion reaches its maximum level at ovulation. Nature has done this to allow ovulation to coincide with a moist, slippery vagina, a lowered uterus, and a ferning pattern in the cervical mucus, all provided by the surge in estrogen levels. The beautiful fernlike pattern in the cervical mucus looks like an evergreen forest seen from a distance, or like cracks on a large sheet of thin ice. The purpose of this ferning pattern, besides entertaining biologists and medical students, is to provide tracks to guide the sperm up toward the open end of the uterus, called the os. Meanwhile, the egg in the ovary is almost ready to drop. (The follicle producing the most estrogen will ripen into a mature egg.) Eventually, around day fifteen in the monthly cycle, the increased estrogen levels trigger a surge of LH, which, along with increased enzymatic activity around the chosen follicle, causes ovulation, which is the release of the mature egg. Ovulation stimulates progesterone production, which comes in very handy in the event of a successful conception.

What Progesterone Does

The second half of the menstrual cycle is called the luteal phase. When the egg is released from the follicle, it bursts through the ovary wall in order to reach the uterus via the fallopian tubes. The ovarian follicle emerges from a mass of yellow cells called the corpus luteum (Latin for yellow body). The corpus luteum then begins to produce progesterone, which supports the growth of an embryo.

Maybe a viable sperm is already lurking in the womb, maybe not. After the LH surge, progesterone begins to wane unless the implantation of an embryo occurs. If pregnancy does occur, hCG (human chorionic gonadatropin) begins to be secreted by the placenta, maintaining the corpus luteum for continued progesterone production until the placenta takes over. It is the hCG levels that are tested in home pregnancy kits; during the first weeks of pregnancy, hCG doubles weekly.

Why Do We Bleed?

If pregnancy does not occur, the corpus luteum dies within twelve days, resulting in rapidly declining levels of progesterone. At the end of the monthly cycles, the endometrium contains newly suffused, coiled arteries that have been building in preparation for ovulation and pregnancy. These now constrict, cutting off oxygen to themselves and the uterine lining, leading to tissue deterioration. At this point the endometrial lining of the uterus begins to slough off. Blood from the ruptured, coiled arteries and disrupted endometrial cells comprises the menstrual flow. Large clots in the menses are chunks of tissue that don’t have time to undergo liquefaction before they are pushed into the vagina, and they are indicative of heavy bleeding. The average blood loss during a period is about one-quarter of a cup, and the average duration of a menstrual period is five days: two days of heavier bleeding, then three days tapering off.

Running Out of Eggs

As Chapter 18 on the ovaries describes, women lose their eggs rapidly, even before their own birth. Today’s woman is likely to live thirty years beyond her so-called fertile years. Because women have fewer pregnancies today, the average woman will have more ovulations and more periods earlier in her life, and will lose her eggs faster than a woman living 100 years ago or more. Running out of eggs sooner means fewer ovulations later, and fewer ovulations means less progesterone will be produced. This is the cornerstone of understanding what leads up to menopause. Progesterone goes away first, followed by the decline of various estrogens, and finally, the tapering off of the testosterone. However, it is important to realize that although progesterone is no longer produced after the cessation of ovulation, women still continue to produce considerable amounts of estrogen and testosterone from their fat cells and their adrenal glands after menopause. The many symptoms that can ensue from diminishing hormone levels will be discussed one by one in the following chapters.

When Do We Stop Bleeding?

First, let’s talk about the weird periods that can start to happen years before hormonal changes are detectable by blood or saliva tests. These weird periods are simply the changing pattern of your menstrual cycle and often the very first hint that menopause is coming, even though it may not be coming for years—maybe as many as ten years. Women can and do get pregnant well into these perimenopausal years, weird periods and all. (I can personally attest to that, having birthed my first child at age forty-two after several months of less than-regular menstrual periods.)

Sometimes, if you’re lucky with your genes, your periods might get lighter and lighter, and further and further apart, and then quietly go away forever. Most women are not so lucky, even with good genes. A typical age to stop bleeding is fifty-one, but a few women continue their menstrual cycles well into their sixties. Many women begin premenopause (also called perimenopause) about four years before that, on average at age forty-seven. Knowing when your mother began her hormonal changes can be useful for you because daughters will often follow their mothers’ patterns (although many women of my mother’s generation experienced surgical menopause, which is much less likely to be used today to treat the symptoms of hormonal change). The average menstrual cycle lasts approximately one month, which is why women who have regular bleeding can time their periods to lunar cycles. A variety of factors can cause this to vary, including travel (especially west to east travel across time zones), stress, dietary changes, and exposure to unusual odors or different levels of light. It is quite normal to have irregularly timed periods as we approach menopause. Most women will experience this to some degree, and will also find that it is more common for the cycles to get shorter than for the periods to get further apart.

What If My Bleeding Is Actually Getting Heavier?

Because of waning progesterone in the perimenopausal phase leading up to menopause, the endometrium tends to shed early. Additionally, a relatively higher concentration of estrogen may exist, also because of lower progesterone. Estrogen is the hormone responsible for the thickening of the uterine lining, a process also known as endometrial proliferation. The net result of this lowering of progesterone in combination with a higher concentration of estrogen is shorter cycles with heavier periods. Not fun. In cases of extremely heavy bleeding (a cup or more of blood per cycle), other more serious causes of endometrial bleeding must be considered. Sometimes heavy vaginal bleeding can be symptomatic of cervical, endometrial, or uterine cancer. Excessive uterine bleeding can also be caused by an IUD or by uterine fibroids.

Fibroids

Uterine fibroids are very common and most women will have some degree of this benign uterine growth during their lifetime. Uterine fibroids are non-cancerous tumors in the uterus made up of smooth muscle cells and connective tissue. While some stay very small, others can cause the uterus to stretch to the size of a five or six-month-pregnant womb. Fibroids often grow during pregnancy, and even more commonly, toward the end of the woman’s reproductive life. It is generally believed that excessive estrogen promotes fibroid growth, but since they are benign many women choose to do nothing unless the fibroids cause heavy bleeding or pressure on the bowel or bladder. A small fibroid measures less than 4 cm in diameter, and I have found that small ones can be readily reduced by an anti-estrogenic diet (no animal products) and acupuncture. Medium-sized fibroids (4-10 cm) are a little tougher to treat but can certainly be reduced non-surgically. Fibroids larger than 10 cm are not easy to reduce by dietary measures alone.

Consult a qualified healthcare professional if you have more than two very heavy periods in a short time span. You will need a pelvic ultrasound to evaluate the thickness of the endometrium (the endometrial stripe) and probably an endometrial biopsy, which is like a PAP smear, but the thin, tissue-collecting instrument goes up through the os into the uterus. If you wish to have a fibroid removed, consider a myomectomy. Also known as leiomyectomy, this procedure involves removal of the fibroid only as opposed to a hysterectomy. A growing number of gynecologic surgeons can now perform this procedure laparoscopically.

When Do I Worry About Heavy Bleeding?

Unless you are losing so much blood that you risk becoming anemic, or are extremely uncomfortable with temporarily irregular menses, know that it is normal to have weird periods for several years before complete cessation of menses. You need to figure out what you want for yourself, and seek help accordingly. For example, some women are attached to their cycles, and want to continue bleeding regularly. This will be especially true of healthy women in their forties who have not borne any children, yet aren’t ready to let go of the idea of becoming biological mothers. Healthy older moms can confer many benefits to their offspring, but the chances of an uncomplicated pregnancy diminish with age.

For women who wish to regularize their cycles, progesterone taken in the luteal phase may do the trick nicely. Older women who conceive while supplementing with progesterone are advised to continue with progesterone supplementation well into the second trimester of the pregnancy because progesterone withdrawal is the main cause of endometrial shedding (menstruation).

If heavy bleeding turns out to be from precancerous cells in the uterine lining, a short course of progesterone may be curative. Another option for controlling heavy bleeding caused by benign or