Natural Approach

GOING THROUGH THE MENOPAUSE - THE NATURAL WAY

Increasing numbers of menopausal women are turning to natural medicine in an attempt to find alternatives to HRT. But natural doesn't always equal safe - and not all the menopause blues can be blamed on hormones.

So what constitutes a prudent natural way through this time of life?

THE hormones estrogen and progesterone begin to decline as we approach the menopause - which is when menstruation finally ceases, typically around 51. The lowered hormone levels are associated with short-term symptoms such as hot flushes, night sweats, thinning hair and skin, depression, sleep difficulties, lowered sex drive, painful intercourse and mood swings. One out of every three women experiences these severely; the others may feel uncomfortable and inconvenienced or wonder what the fuss was about.

There are also long-term health concerns to think about as post-menopausal years carry more risk of heart problems, stroke and weakening of bones. Add to this the fact that a woman has to come to terms with the end of her reproductive years and loss of youth, and it's no wonder that this can be a difficult season.

While HRT can be safely used under certain conditions, many women look to Complementary and Alternative Medicine (CAM) for help. Some cannot tolerate the side-effects that occur in some women taking HRT (EG bloating, headaches, water retention and nausea). Others are fearful of the adverse effects associated with HRT and believe that ‘natural' therapies are safer. And there are women who prefer to journey through their menopausal years without further synthetic manipulation of their hormones, preferring CAM therapies as a mirror of their values and beliefs.

The SA Menopause Society is not against such options but is concerned about the limited scientific evidence for CAM effectiveness. This is not stopping the use of herbal preparations and plant-based hormones however so it is important to know what risks and benefits are associated with these options as many women bring the same set of expectations to natural preparations as were applied to HRT. There is the assumption that all the problems during this time are due to hormones - especially oestrogen deficiency - which is not correct. The effects of chronic stress catch up with a woman, as can nutritional imbalances and deficiencies, relationship crises and lack of exercise - so making changes to lifestyle can go a long way to help one feel better and improve health.

The menopausal transition is a time to assess and manage a wide range of health matters that can affect women in their mid and later lives. SAMS recommends that one monitors for:

• diabetes
• high blood pressure
• bone density (a special form of X-ray called a DEXA scan is quick to do and very accurate)
• breast health - SAMS recommends all post-menopausal women have an annual mammogram
• cervical health with regular PAP smears
• heart and arterial health.

Changing habits

Lifestyle changes make a difference to health but this really is a time to take them seriously. They include stress reduction, stopping smoking and, if necessary, examining emotional issues. Regular exercise is vital, especially if leading a stressful but sedentary life. Whether it's walking, dancing, cycling or yoga, exercise appears to reduce hot flushes and can offset depressive tendencies. Some form of resistance or weight training is recommended to maintain bone density. Deep breathing and relaxation help interrupt the stress cycle which eases hot flushes.

Correct nutrition keeps the body in balance and allows hormones to work to the optimum during the menopausal years. So:

• stabilise blood sugar levels by cutting back refined foods and stimulants (especially tea, coffee, spicy foods and alcohol) and increasing complex carbohydrates, fresh vegetables and fruit
• reduce intake of red meat (it intensifies oestrogen deficiency & depletes calcium)
• ensure adequate intake of essential fatty acids - either as supplements or via cold-pressed virgin oils
• eat fibre from natural sources such as brown rice, whole wheat, beans, nuts, seeds, fruit and vegetables
• reduce sodium intake (mostly in table salt) to help the body balance blood pressure and water retention.
• supplement with EG vitamin E and selenium for heart health and hot flushes; vitamin C for hot flushes; calcium (carbonate, citrate or chelate), magnesium, phosphorous and vitamin D for bone loss;
• B vitamins for dry skin and hair
• limit alcohol (especially red wine).

Homoeopathy is sometimes used by menopausal women and treats the whole person rather than the problem. A carefully chosen constitutional remedy by a qualified practitioner will engage mental and emotional dimensions as well as the physical. Common remedies are Lachesis for hot flushes, Pulsatilla for insomnia and joint pain, and Sepia for flushes and thinning skin and hair.

Plant hormones

The most studied CAM options for menopause are plant or phyto-estrogens that have an estrogen-like effect in the body. There are three main groups and they occur in about 300 plants - especially the legume family. Isoflavones are the most common form of plant oestrogen and are found in abundance in soybeans. SAMS notes that the most convincing health effects attributed to soy protein supplements are a reduction in cholesterol, some increase in spinal bone and - in some studies - an improvement in hot flushes. It's still uncertain whether breast cancer survivors should supplement with this form of plant oestrogen.

Isoflavone levels are high in the red clover plant and it is used in the form of standardized supplements such as Promensil. Clinical trials show it to raise ‘good' cholesterol levels, improve arterial health and possibly reduce hot flushes and loss of spinal bone density. Clinical trials have however not shown consistent results. No adverse effects have been reported but red clover may interfere with hormonal therapies and drugs that prevent blood clotting.

The most widely studied herb for menopause support is black cohosh, a plant used traditionally by Native Americans. In clinical trials, black cohosh performed better than placebo in improving hot flushes, depression and general well-being. The evidence is promising but there are no published studies on its efficacy beyond six months. Side-effects such as rashes and gastric disturbance have been observed.

In Chinese medicine, dong quai is the most extensively used herb for gynaecological conditions. The results of the only clinical trial that tested the herb for its effect on hot flushes over 12 weeks were disappointing but traditional herbalists argue that it is not meant to be used in isolation but with an individually tailored mix of herbs.

‘Natural' progesterone, generally rubbed into the skin as a cream, has found a popular following. The progesterone is chemically identical to the hormones produced in the body but is made in the laboratory from a plant hormone called diosgenin that is extracted from wild yam and (more likely these days) soya beans. Proponents of this form of hormone therapy suggest it is necessary to off-set what they see as a problem of oestrogen dominance in the body - caused by oestrogen-like substances absorbed from a toxic and polluted environment.

Its supporters claim a wide range of benefits from relief of depression and dry skin to insomnia, joint pain and poor concentration but controversy persists around it. Not only is it difficult to ascertain the level of progesterone in the cream but some studies question how much is absorbed through the skin and, if it is, how evenly it is distributed through the body.

Supplements of evening primrose oil (from 1 500 to 3 000mg daily) were found in one study to reduce night flushes but side-effects such as inflammation, nausea and thrombosis have been noted. Poor concentration and memory have prompted women to look to the herb gingko biloba for improved mental functioning. Preparations from the leaves have been used in traditional medicine to improve circulation and thin the blood. Some well-controlled trials showed benefit for blood flow to the brain but there can be side-effects such as digestive distress, headache and bleeding (the herb inhibits the capacity of the blood to thicken).

The depression experience has prompted a look at the medicinal plant St John's wort. A number of trials have tested it as a treatment for mild to moderate depression, and it was found to be better than placebo and as effective as standard anti-depressants. It should not be used in conjunction with the latter drugs however and may interfere with the action of medications such as blood thinners and the Pill.

A woman going through the menopause should formulate an individualized package of lifestyle change and health monitoring with her medical professional. If topping up the body's oestrogen and progesterone with nutraceuticals, herbs or plant extracts, remain alert for the effects of this form of HRT (especially if susceptible to oestrogen-related cysts and fibroids) and continue to observe breast health and thyroid hormone levels. Allow several months for changes in diet, supplements and lifestyle to make their benefits felt.