Columns

Part II of a Two Part Series from Dr. Barufaldi's popular lecture

Baby Boomer women are now moving into menopause. You can hear hot flashes and "menopause moments" being discussed wherever women congregate these days. Last month we discussed the fact that menopause is a natural transition, not a disease. As a natural transition, it can be dealt with naturally, without the hormone replacement drugs which can increase the risk of breast cancer, coronary heart disease, stroke and blood clots in the lungs.

The body of a menopausal woman makes a biochemical shift from manufacturing the sex hormones of estrogen, progesterone and testosterone primarily in the ovaries. After menopause, the manufacture of these hormones is taken back by the adrenal glands, the glands that produced these hormones during childhood before sexual maturation occurred. The adrenal glands can make chemical molecules which can then be transformed into progesterone, estrogen, testosterone and cortisol, the primary stress hormone. And there's the rub. The more stress she is under, the more of the adrenal glands' work must go to producing cortisol and the less the sexual hormones can be produced. So the more stressful the life, the more difficult and symptomatic the menopause.

What should a woman experiencing symptoms during perimenopause or menopause do? A lot of things. All of them are aimed at giving her body the support it needs to allow the adrenal glands to function optimally and to normalize her body chemistry.

Before we get into specific symptom relief, I want to stress that vitamins, minerals and herbs should be of very high quality. The standardization and production of vitamins needs to be done carefully and must start with the highest quality ingredients. If the pills are cheaper but don't work, you have lost money, not saved money. I am not recommending specific doses because the appropriate dose will vary with age, body size, medical history, and other medicines and supplements taken. Consultation with a professional is well worth the modest fee to fine tune the herb choice, dosage, timing of dose, etc. Finally, if you do choose to just try things out of the health food store, never exceed the maximum dose on the label and stop immediately if your symptoms get worse or don't respond. As we proceed, you will see how complicated menopause can be and how much the guidance of a professional can help you cut to the chase in treatment options.

First, any woman in menopause or perimenopause needs to be taking a good multi vitamin with minerals. Calcium supplementation with magnesium is important to work against osteoporosis, or loss of bone density, that can accompany menopause.

The second thing any menopausal or perimenopausal woman (anyone between 35 and 65) needs to do is to support the adrenals. Cordyceps, Asian ginseng and rhodiola are herbs which are helpful in appropriate dosages.

Calcium is of little use without exercise to get the calcium into the bones. At least 20 minutes of weight bearing cardiovascular exercise 3 to 4 times a week is key to enhancing biochemical balance. Adequate sleep is required, and most need 7 to 8 hours per night. Some need more. A reasonable diet, high in fiber and vegetables, low in refined sugar, caffeine, alcohol and fat, will give the body the raw materials it needs to produce the hormones you need.

Now let's get down to the hot flashes…..

The three major hormones that fluctuate in menopause are estrogen, progesterone and testosterone. So during the transition of menopause, estrogen may be normal or low, progesterone may be normal or low, and testosterone may be normal, low or high. Add to this the fact that progesterone is a precursor molecule to estrogen, testosterone and cortisol, and you get some idea of how complicated this can get. But I digress.

Low estrogen can result in hot flashes, a sudden feeling of overall, extreme heat. (If you're wondering if you're having one, you're not). Other symptoms can be mental and physical depression, fatigue, a feeling of being weighted down, and a decrease in verbal skills, especially inability to think of a word or a name (the "menopause moment").

Others include vaginal dryness and stress incontinence (inability to keep urine from leaking out during a sneeze or cough). Low estrogen is also linked to bone loss and heart disease. These symptoms can generally be treated with phytoestrogens like soy, alfalfa, dong quai, sage. Fatigue responds to ginseng, licorice and rehmania. Black cohosh (not blue cohosh, which has been linked to high blood pressure and abdominal irritation) is not a phytoestrogen; it's a plant progesterone but since progesterone is a precursor to estrogen, it can sometimes help these problems. For other women, it may make these problems worse.

Low progesterone results in feelings of unrest, uneasiness, nervousness, jittery feelings, a fatigue that is unsettling. Often this results in sleep disturbance (although so can estrogen deficiency). When there is a low progesterone to estrogen ratio, increased pain due to increased inflammation and allergies can result. Stress makes this problem (and all menopause symptoms) worse. Herbal remedies include black cohosh, wild yam (but not the cream. There are problems with dose due to inconsistencies in concentration within the products and in absorption through the skin. Even worse, the wild yam cream often results in high levels of progesterone in the liver, where it can harm you and where it does no good in treating your symptoms.) Other herbs are skullcap, valerian, Siberian ginseng, barbasco and St. John's wort (which can interfere with birth control pills).

Low testosterone can leave you feeling without normal vim and vigor, loss of libido, procrastinating. It can also cause hot flashes and increase your risk of bone loss. Long term, it can increase your risk of angina, a kind of heart problem. To help, add boron to your minerals. Try DHEA, which is a precursor to both estrogen and testosterone, but it doesn't work for everyone. You can try taking more progesterone which is a precursor to testosterone, but be careful not to exceed safe levels. They should be monitored by a professional.

High testosterone leaves you agitated and angry, frustrated. It also can cause increased facial hair, oily skin and acne. It increases your risk of diabetes, heart disease, breast cancer and endometrial cancer. Try chasteberry, hops or saw palmetto. Avoid boron.

These deficiencies and excesses can occur in combination with each other. Also symptoms due to thyroid deficiency and excess are common at this time of life. If you've followed this train of thought this far, you have figured out that it can be a very confusing road. I use an extensive symptom questionnaire with a mathematical analysis to get some initial clarity. Follow up labs can further clarify your situation. The bottom line here is that natural menopause treatment works. You don't need to use dangerous drugs and you don't need to suffer through it.

<< Part I