Menopause: A Natural Process of Change

by Renee Lang, ND

Definitions

Menopause is a natural transition in a women’s life. Currently there are about 50 million menopausal women in the US, and that number is expected to increase to nearly 50% of the total US population by 2014. Menopause is defined as the permanent cessation of menstruation due to loss of ovarian follicular activity. Menopause occurs when a women has 12 consecutive months without a menstrual period. The average age of menopause is 51, however, women may go through menopause as early as 39 or as late as 54.

In the three to five years prior to menopause, called perimenopause, a woman may begin to experience a variety of common symptoms including: hot flashes, waking in the middle of the night around 2-3am “for no apparent reason,” night sweats, irritability, irregular menses, memory loss and/or brain fog, decreased libido, vaginal dryness, weight gain, insomnia, and poor concentration. However, there is no rule that states that a woman must experience any of these symptoms. In fact, in some cultures women don’t have any of these symptoms, and look forward to ending their “duties” of child bearing to become wise elders.

Surgical menopause, the removal of both ovaries, is a different experience of menopause and is not subject to the above timeline. Women who have undergone surgical menopause often experience more severe symptoms and often require hormone replacement. This hormone replacement is used to treat symptoms and to prevent osteoporosis, which becomes more likely due to the abrupt loss of both progesterone and estrogen. In addition, these women will often benefit from the addition of testosterone and/or DHEA into their hormone regimen. Although the adrenals will help with hormone production, it has been shown that they do not function as well without the presence of ovaries.

Physical Changes

The first sign that the hormone cycle is changing usually occurs in the mid to late thirties and is experienced as irregular menses or missed periods. This occurs as a result of the decline in ovarian function and the intermittent loss of ovulation. Without ovulation only small amounts of progesterone are produced to offset the effects of estrogen and to provide balance. What occurs is a relative estrogen dominance. In the beginning this is erratic and occasional; however, as the woman ages it becomes more consistent and the menstrual cycle becomes anovulatory (without ovulation). As a woman experiences more and more months in the estrogen dominant state, she becomes increasingly susceptible to “menopausal” symptoms.

Without ovulation the only source of progesterone available in the body comes from the small amount produced by the adrenal glands. Producing progesterone is not the primary role of the adrenal glands. The adrenal glands have other responsibilities in the body, which tend to override the production of progesterone on the priority list. The role that tends to take center stage with the adrenal glands is stress management. They are responsible for producing the stress hormone adrenaline and to help the body cope with stress on a day-to-day basis. When an individual experiences chronic, daily stress the ability of the adrenal glands to provide an adequate source of progesterone is compromised. This may predispose those women under chronic stress to a more difficult or more symptomatic experience of menopause. Therefore, stress management and adrenal support and nourishment are important during the transition into menopause.

Diagnosis

Menopause is primarily diagnosed by a woman’s symptomatic picture and the clinical assessment of her menstrual cycle, and from her family history. If this information is complicated by other factors or if verification is needed for any other reason, then testing for elevated blood levels of the hormone FSH can provide a definitive diagnosis. However, listening to a woman and assessing her symptom picture is one of the most effective ways to determine if she is beginning her transition. Based on her age and account of the past year or so of menstrual changes and symptoms, it can be pretty clear where she is in this process.

Treatment

Menopause is not a disease. Let me say that again, Menopause is not a disease. There is no absolute requirement for treatment. The decision to treat menopausal symptoms is entirely up to the individual woman. If the symptoms are not interfering with her quality of life in a significant manner, as determined by her, than she may not need treatment of any kind. The reason I say may not instead of does not is because post-menopausal women become susceptible to many other conditions and if she has risk factors for these conditions then preventative measures must be put in place. These conditions include osteoporosis, arthritis, breast cancer, and heart disease (the number one killer of women).

If a woman does decide to explore treatment there are many options available. These options include (in ascending order of invasiveness): Diet changes, lifestyle changes, homeopathy, supplements, herbal remedies, and finally, bio-identical hormones. Diet and lifestyle recommendations often include decreasing caffeine, sugar, alcohol, smoking, and refined carbohydrates. They also include increasing dark leafy greens, ground flax seeds (not flax oil), consistent exercise, stress management, and getting adequate sleep. Homeopathy, herbal remedies, and supplements are prescribed on an individual basis. The most common herbs utilized in the treatment of menopausal symptoms include Black cohosh and Chaste tree berry. Although these herbs are relatively safe to use, they should be used under the supervision of a qualified practitioner.

Bio-identical hormones are laboratory-produced hormones from plant materials that are biochemically identical to the hormones found within a woman’s body. Hormones often used in the treatment of menopause symptoms include progesterone and estrogen, and sometimes testosterone. The use of these hormones should be done under the supervision of a physician to ensure proper, effective, dosing. An integrated approach is often necessary in order to achieve the results desired by women.