Menopause: Disease or
by Mary Ann Mayo & Joseph L.
September 4, 1999
It's front-page news. It's
politically correct and socially acceptable. Talking about
menopause is in. Suddenly it's cool to have hot flashes.
Millions of women turning 50 in the next few years have
catapulted the subject of menopause into high-definition
It's about time. Rarely discussed openly by women (what
did your mother ever advise you?), meno-pause until recently
was dismissed as "a shutting down experience characterized
by hot flashes and the end of periods." Disparaging and
depressing words like shrivel, atrophy, mood swings and
melancholia peppered the scant scientific menopausal
What a difference a few years and a very vocal, informed
and assertive group of Baby Boomers make. Staggered by the
burgeoning numbers of newly confrontational women who will
not accept a scribbled prescription and a pat on the head as
adequate treatment, health practitioners and researchers
have been challenged to unravel, explain and deal with the
challenges of menopause.
Not An Overnight Sensation
Menopause, researchers have discovered, is no simple, clear
cut event in a woman's life. The "change of life" does not
occur overnight. A woman's body may begin the transition
toward menopause in her early 40s, even though her last
period typically occurs around age 51. This evolutionary
time before the final egg is released is called the
perimenopause. Erratic monthly hormone levels produce
unexpected and sometimes annoying sensations.
Even as their bodies adjust to lower levels of estrogen,
progesterone and testosterone, some women don't experience
typical signs of menopause until after the final period. A
fortunate one-third have few or no discomforts.
According to What Your Doctor May Not Tell You About
Premenopause (Warner Books) by John R. Lee, MD, Jesse
Hanley, MD, and Virginia Hopkins, "The steroid hormones are
intimately related to each other, each one being made from
another or turned back into another depending on the needs
of the body...But the hormones themselves are just part of
the picture. It takes very specific combinations of
vitamins, minerals and enzymes to cause the transformation
of one hormone into another and then help the cell carry out
the hormone's message. If you are deficient in one of the
important hormone-transforming substances such as vitamin B6
or magnesium, for example, that too can throw your hormones
out of balance. Thyroid and insulin problems, toxins, bad
food and environmental factors, medication and liver
function affect nutrient and hormone balance."
The most important reproductive hormones include:
Estrogen: the female hormone produced by the ovaries from
puberty through menopause to regulate the menstrual cycle
and prepare the uterus for pregnancy. Manufacture drops
significantly during menopause. Estradiol is a chemically
active and efficient form of estrogen that binds to many
tissues including the uterus, breasts, ovaries, brain and
heart through specific estrogen receptors that allow it to
enter those cells, stimulating many chemical reactions.
Estriol and estrone are additional forms of estrogen.
Progesterone: also produced by the ovaries, it causes
tissues to grow and thicken, particularly during pregnancy,
when it protects and nurtures the fetus. Secretion ceases
Testosterone: Women produce about one-twentieth of what
men do, but require it to support sex drive. About half of
all women quit secreting testosterone during menopause.
Estrogen's Wide Reach
Since estrogen alone influences more than 400 actions on the
body, chiefly stimulating cell growth, the effects of its
fluctuations can be far-reaching and extremely varied: hot
(and cold) flashes, erratic periods, dry skin (including the
vaginal area), unpredictable moods, fuzzy thinking,
forgetfulness, fatigue, low libido, insomnia and joint and
Young women may experience premature menopause, which can
occur gradually, as a matter of course, or abruptly with
hysterectomy (even when the ovaries remain) or as a result
of chemotherapy. Under such conditions symptoms can be
In the 1940s doctors reasoned that if most discomforts
were caused by diminishing estrogen (its interactive role
with progesterone and testosterone were underestimated),
replacing it would provide relief. When unchecked estrogen
use resulted in high rates of uterine cancer, physicians
quickly began adding progesterone to their estrogen regimens
and the problem appeared solved.
For the average woman, however, hormone replacement
therapy (HRT) became suspect and controversial, especially
when a link appeared between extended use of HRT (from five
to 10 years) and an increase in breast and endometrial
cancers (Journal of Clinical Pharmacology 37, 1997). The
result: Women have drawn a line in the sand between
themselves and their doctors.
Resolving The Impasse
Since hormone replacement reduces the risk of major maladies
like heart disease, osteoporosis, Alzheimer's, colon cancer
and diabetes that would otherwise significantly rise as
reproductive hormone levels decrease, most doctors recommend
hormone replacement shortly before or as soon as periods
stop. Hormone replacement also alleviates the discomforts of
But only half of all women fill their HRT prescriptions
and, of those who do, half quit within a year. Some are
simply indifferent to their heightened medical risks. Some
are indeed aware but remain unconvinced of the safety of HRT.
Others complain of side effects such as bloating, headaches
Women's resistance to wholesale HRT has challenged
researchers to provide more secure protection from the
diseases to which they become vulnerable during menopause,
as well as its discomforts. If the conventional medical
practitioners do not hear exactly what modern women want,
the complementary medicine community does. Turning to
centuries-old botanicals, they have validated and compounded
them with new technology. Their effectiveness depends on
various factors including the synergistic interaction of
several herbs, specific preparation, the correct plant part
and dosage, harvesting and manufacturing techniques.
Research demonstrates that plant hormones (phytoestrogens)
protect against stronger potentially carcinogenic forms of
estrogen while safely providing a hormone effect. Other
herbs act more like tonics, zipping up the body's overall
Help From Herbs
Clinical trials and scientific processing techniques have
resulted in plant-based supplements like soy and other
botanicals that replicate the form and function of a woman's
The complementary community also can take credit for
pushing the conventional medical community to look beyond
estrogen to progesterone in postmenopausal health.
Natural soy or Mexican yam derived progesterone is
formulated by pharmacologists in creams or gels that prevent
estrogen-induced overgrowth of the uterine lining (a factor
in uterine cancer), protect against heart disease and
osteoporosis and reduce hot flashes (Fertility and Sterility
69, 1998: 96-101).
A quarter of the women who take the popularly prescribed
synthetic progesterone report increased tension, fatigue and
anxiety; natural versions have fewer side effects.
These "quasi-medicines," as Tori Hudson, a leading
naturopathic doctor and professor at the National College of
Naturopathic Medicine, Portland, Oregon, calls them, are
considered "stronger than a botanical but weaker than a
medicine." (Hudson is author of Gynecology and Naturopathic
Medicine: A Treatment Manual.)
According to Hudson, the amount of estrogen and
progesterone in these supplements is much less than medical
hormone replacement but equally efficacious in relieving
menopausal problems and protecting the heart and bones.
According to a study led by Harry K. Genant, PhD, of the
University of California, San Francisco, "low-dose" plant
estrogen derived from soy and yam, supplemented with
calcium, prevents bone loss without such side effects as
increased vaginal bleeding and endometrial hypoplasia,
abnormal uterine cell growth that could be a precursor to
endometrial cancer (Archives of Internal Medicine 157, 1997:
These herbal products, including natural progesterone and
estrogen in the form of the weaker estriol or estrone, may
block the effect of the stronger and potentially
Soy in its myriad dietary and supplemental forms provides
a rich source of isoflavones and phytosterols, both known to
supply a mild estrogenic effect that can stimulate repair of
the vaginal walls (Journal of the National Cancer Institute
83, 1991: 541-46).
To enhance vaginal moisture, try the herb cimicifuga
racemosa, the extract of black cohosh that, in capsule form,
builds up vaginal mucosa (Therapeuticum 1, 1987: 23-31).
Traditional Chinese herbal formulas containing roots of
rehmannia and dong quai have long been reputed to promote
Clinical research in Germany also confirms the usefulness
of black cohosh in preventing hot flashes and sweating, as
well as relieving nervousness, achiness and depressed moods
caused by suppressed hormone levels. It works on the
hypothalamus (the body's thermostat, appetite and blood
pressure monitor), pituitary gland and estrogen receptors.
Green tea is steeped with polyphenols, mainly flavonoids,
that exert a massive antioxidant influence against
allergens, viruses and carcinogens. The risks of
estrogen-related cancers such as breast cancer are
particularly lowered by these flavonoids, as these
substances head directly to the breast's estrogen receptors.
About three cups a day exert an impressive
anti-inflammatory, antiallergenic, antiviral and
Other phytoestrogen-rich botanicals, according to Susun
Weed's Menopausal Years: The Wise Woman Way (Ash Tree
Publishing), include motherwort and lactobacillus
acidophilus to combat vaginal dryness; hops and nettles for
sleep disturbances; witch hazel and shepherd's purse for
heavy bleeding; motherwort and chasteberry for mood swings;
dandelion and red clover for hot flashes.
Our Need For Supplements
Adding micronutrients at midlife to correct and counter a
lifetime of poor diet and other habits is a step toward
preventing the further development of the degenerative
diseases to which we become vulnerable. At the very minimum,
you should take:
a multivitamin/mineral supplement vitamin E calcium
Your multivitamin/mineral should contain vitamins A, B
complex, C, D, E, calcium, magnesium, potassium, copper and
zinc. Look for a wide variety of antioxidants that safeguard
you from free radical damage, believed to promote heart
disease and cancer, as well as contribute to the aging
Also on the list: mixed carotenoids such as lycopene,
alpha carotene and vitamin C; and folic acid to help
regulate cell division and support the health of gums, red
blood cells, the gastrointestinal tract and the immune
Studies indicate a deficiency of folic acid (folate) in
30% of coronary heart disease, blood vessel disease and
strokes; lack of folate is thought to be a serious risk
factor for heart disease (OB.GYN News, July 15, 1997, page
Extra vitamin E is believed to protect against breast
cancer and bolster immune strength in people 65 and older
(Journal of the American Medical Association 277, 1997:
1380-86). It helps relieve vaginal dryness, breast cysts and
thyroid problems and, more recently, hit the headlines as an
aid in reducing the effects of Alzheimer's and heart
disease. It is suspected to reduce the thickening of the
carotid arterial walls and may prevent the oxidation of LDL
(bad) cholesterol, which contributes to the formation of
plaque in arteries.
Selenium also has been identified as an assistant in
halting cancer (JAMA 276, 1996: 1957-63).
The Omegas To The Rescue
Essential fatty acids found in cold water fish, flaxseed,
primrose and borage oils and many nuts and seeds are
essential for the body's production of prostaglandin,
biochemicals which regulate hormone synthesis, and numerous
physiological responses including muscle contraction,
vascular dilation and the shedding of the uterine lining.
They influence hormonal balance, reduce dryness and relieve
In addition, the lignans in whole flaxseed behave like
estrogen and act aggressively against breast cancer,
according to rat and human studies at the University of
Toronto (Nutr Cancer 26, 1996: 159-65).
Research has demonstrated that these omega-3 and omega-6
fatty acids can reverse the cancer-causing effects of
radiation and other carcinogens (Journal of the National
Cancer Institute 74, 1985: 1145-50). Deficiencies may cause
swelling, increased blood clotting, breast pain, hot
flashes, uterine and menstrual cramps and constipation.
Fatigue, lack of endurance dry skin and hair and frequent
colds may signal EFA shortage. Plus, fatty fish oils, along
with vitamin D and lactose, help absorption of calcium, so
vital for maintaining bone mass.
In addition, studies show that the natural substance
Coenzyme A may help menopausal women reduce cholesterol and
increase fat utilization (Med Hyp 1995; 44, 403, 405). Some
researchers belive Coenzyme A plays a major role in helping
women deal with stress while strengthening immunity.
Can't shake those menopausal woes? Menopause imposters may
be imposing on you: The risk of thyroid disease, unrelenting
stress, PMS, adrenal burnout, poor gastrointestinal health
and hypoglycemia all increase at midlife. Menopause is a
handy hook on which to hang every misery, ache and pain but
it may only mimic the distress of other ailments. For this
reason every midlife woman should have a good medical exam
with appropriate tests to determine her baseline state of
health. Only with proper analysis can you and your health
practitioner hit on an accurate diagnosis and satisfying
course of therapy.
And if menopause is truly the issue, you have plenty of
company. No woman escapes it. No woman dies from it. It is
not a disease but a reminder that one-third of life remains
to be lived. Menopausal Baby Boomers can anticipate tapping
into creative energy apart from procreation. If not new
careers, new interests await. An altered internal balance
empowers a menopausal woman to direct, perhaps for the first
time, her experience of life. She has come of age-yet again.
Gone is the confusion, uncertainty, or dictates of a hormone
driven life: This time wisdom and experience direct her.
There is no need to yearn for youth or cower at the
conventional covenant of old age. Menopause is the clarion
call to reframe, reevaluate and reclaim.
Mary Ann Mayo and Joseph L. Mayo, MD, are authors of The
Menopause Manager (Revell) and executive editors of Health
Opportunities for Women (HOW). Telephone number 877-547-5499
for more information.