Menopause is discussed a lot more nowadays than in the past, possibly due to the fact that previous generations did not talk as much about their bodies and lifestyles were different – women had children younger, retired younger and perhaps went more willingly into the idea of old age.
The actual definition of menopause is the permanent cessation of periods and is usually diagnosed in retrospect, when one year has passed since the last period.
Before the actual menopause, women go through the perimenopause which is the transitional period from normal menstrual periods to no periods at all. The transition can last up to 10 years.
The perimenopause is what used be known as “going through the change”, which is exactly what it is ,the transition period in your body from being able to produce eggs to the complete cessation or menopause.
There is no definite time for the menopause to start but it usually falls in the age range of 44 – 55.
The reason for the change is all down to hormones. The hormones oestrogen and progesterone regulate menstruation. As time passes and the ovaries produce fewer and fewer oestrogen and progesterone, the ovaries eventually shut down completely and the woman no longer has menstrual periods.
Dr. Sook Yin, who sees women at her practice going through the menopause says, “The decline of hormones can cause a range of symptoms including mood changes, anxiety, depression, night sweats, hot flashes, fluctuations in sleep patterns, loss of libido and gaining weight around the stomach.”
Other things to look forward to after the menopause are lower oestrogen levels, which reduce protection against heart attacks, and a gradual but progressive loss of bone mass, or ‘osteoporosis’, which leads to a greater risk of fractures in later life, particularly hip fractures.
The severity of menopausal symptoms can vary from woman to woman and perhaps the main difference between the present generation of women going through menopause and their grannies is that they do not expect just to endure symptoms. As Yin points out, “women expect a lot more from their bodies nowadays and do not expect them to let us down.”
Medicine seemed to have found the magical answer to menopausal symptoms with hormone replacement treatment (HRT), using synthetically produced hormones, but there was an abrupt awakening in 2002 when the US federal government halted the hormone trial of the Women’s Health Initiative early.
A study designed to evaluate the risks and benefits of synthetic hormone replacement therapy on disease prevention instead showed that there was an increased risk of breast cancer, heart disease, stroke and blood clots. The study was done on a combined pill that used progesterone and oestrogens – the oestrogens being derived from mare’s urine.
Women came off HRT in panicked droves and doctors were not so keen to prescribe.
Many women turned to natural remedies to treat the symptoms – traditional herbal remedies such as black cohosh and oestrogen-rich foods such as soy products.
Opinion is divided how effective this type of supplementation is and for some women, it is just not enough.
Some doctors advocate the use of bio-identical hormones which are made from botanical plants like soya and yams.
The human body cannot convert soya or yams directly into natural hormones, so the natural plants must be pharmaceutically processed to produce natural bio-identical progesterone and oestrogens.
The theory is that these hormones are identified by the human body as being biologically identical to the natural hormones of the body and the body responds to the hormones as if they were the naturally produced, identical, biological structure of the hormones of the body, rather than as a foreign substance being introduced.
One of the foremost proponents of the use of bio-identical hormones is Canadian gynaecologist Alvin Pettle, who visited Cayman earlier this year.
So what is the difference between these and commercially produced plant-based hormones in HRT that are already in use? Yin makes the analogy that it’s the difference between buying an off-the-peg suit and a tailor-made one, that commercial plant-based HRT uses the one size fits all concept, whereas bio-identical hormones can be compounded to fit a particular prescription for an individual.
They are also usually given in cream form and absorbed through the skin rather than in tablet form.
Getting it right
Dr. John Addleson has been treating women using bio-identical hormones for the last 12-15 years. If a patient presents with symptoms, he will analyse her level of hormones by testing urine samples taken over 24 hours. This shows how hormone levels are fluctuating over that period.
There is a range of hormone levels over the various stages of a woman’s life that give an estimate of where levels should be.
Addleson says, “Taking into account height and weight and adding in symptoms together with the urine profile, you then try and design a formula that suits that patient.” The prescription is then given to a chemist to formulate. Currently, this is done in the United States.
He says, “Typically a prescription would be made up using Mexican wild yam, black cohosh, red clover and soya.”
The prescription comes in the form of a cream that is pre-measured in a syringe so that women know how much to apply daily. There has not been a huge amount of studies done on the effectiveness of bio-identical hormones, but Addleson says that the effectiveness is shown by whether a woman’s symptoms have gone.
Gynaecologist Barry Richter is not entirely convinced about bio-identicals. He points out that plant-derived HRT already exists in commercial preparations such as Estrace, which uses soy plant and yams as the source material.
“Pharmaceutical hormones are regulated and manufactured to certain standards” with some, although not all bio-identicals being FDA-approved,” he says.
He adds that “some bio-identicals are compounded, not all are though.”
The difference he sees is that using a commercial product such as Estrace, women have the security of knowing they are manufactured under strict controls.
Also, if a patient presents with menopausal symptoms, he would not necessarily measure hormones, he would look at the symptoms and treat them.
There is also cost to consider, a month’s supply of a compounded bio-identical hormones costs around $90 compared to commercially prepared Estrace which would cost about $40 to $50.
Ultimately, the choice of whether to use HRT in any form is up to each individual woman in discussion with her doctor and taking into account symptoms and previous medical history.
Exercise, exercise, exercise!
For many women, proper nutrition and exercise can help alleviate symptoms.
Research shows that exercise alone can alleviate hot flashes.
In one study, aerobic exercise reduced the severity of hot flashes in 55 per cent of post-menopausal women. For many women, choosing not to take HRT, regular weight-bearing exercise and strength training can also help maintain strong bones.
Another study conducted at Tufts University on the benefits of weight training.
compared two groups of healthy postmenopausal women who were sedentary at the start of the programme. One group lifted weights for 40 minutes twice a week; the other group remained sedentary.
The sedentary control group lost about two per cent of their bone density during the year, while the strength-training women gained one per cent in bone density.
Another study of menopausal women found a 3.5 per cent increase in lumbar spine among women who exercised, compared to a 2.7 per cent decrease in the group of women who didn’t exercise.
Iliana Eastman from Bliss Living and Yoga centre says that yoga combined with breathing and meditation exercises can greatly help with menopausal symptoms. She teaches Kundalini yoga. “Through a combination of poses, breathing and meditation techniques, it works on our glandular and nervous system.”
She says, “Yoga is excellent in preventing osteoporosis as yoga poses use opposing muscles groups that apply pressure to bones and stimulate the bone cells.”
Yoga poses also improve the flexibility of the joints by increasing circulation.
Of particular importance are poses that maintain the flexibility and openness of the hips that are prone to osteoporosis. Similarly, focus is put on maintaining the flexibility of the spine.
Meditation is also very important in calming and restoring the body. Eastman says that “meditative techniques used can produce a deep state that is as restorative as a night’s sleep”.
This can be combined with styles of breathing that can deal with anxiety and even addictions.
“Women expect a lot more from their bodies nowadays and do not expect them to let us down” Dr. Sook Yin