by: Carolyn De Marco, MD
MENOPAUSE: THE GOOD, THE BAD AND THE EXCITING
by Carolyn De Marco, MD
Carolyn De Marco, M.D. is a well-known author and journalist who specializes in women's health and alternative medicine. She has been a pioneer in natural childbirth and in the campaign to raise public awareness about the overuse of drugs and surgery in women's health care. She has lectured throughout Canada and the U.S. and frequently appeared on radio and television. Dr. De Marco is the author of the best selling book on womens health entitled, Take Charge of Your Body: Womens Health Advisor. Her new book Dr. De Marco Answers Your Questions is a mini-encyclopedia on natural remedies for over 100 conditions. View her books at www.demarcomd.com.
Menopause is a radical transition into another stage of life, and in many cultures it is the beginning of a more spiritual orientation towards life.
STAGES OF MENOPAUSE
Thepre-menopause can start as early as age 35 and go up to age 50, and it is a more tumultuous time than the actual menopause because the hormones are fluctuating. In particular, the estrogen is often very high (higher than it is when you are in your twenties), or going up and down, and the progesterone and testosterone are frequently low, particularly from adrenal stress. Menopause itself is actually a quieter time and the hormones stabilize. In post-menopause, all hormones are at lower levels. We actually dont know what is normal for the post-menopause period; we dont know at which level the hormones should cycle. That is something that we are still researching, but it does seem to be helpful for the female body to have at least some level of hormones. We do naturally produce these hormones for many, many years after menopause, for at least ten years especially if we maintain a state of health and balance.
BALANCING YOUR HORMONES
There are a lot of different types of hormones: estrogen, progesterone, testosterone, DHEA, cortisol, thyroid hormone and pregnenolone, which is another master hormone. The hormonal shift at menopause is a gigantic wakeup call and the more we have ignored our lifestyle, the bigger the wake-up call is. Dr. Christiane Northrup says in her book, The Wisdom of Menopause (an excellent new book), that the hormone system goes out of balance because something is out of balance in our lives. It could be an unsatisfactory situation like an unsatisfactory relationship. If you're drinking a lot of coffee, eating a lot of sugar, your adrenals and thyroid will be stressed, or if you have liver dysfunction, you will experience a lot more menopausal symptoms. You will be much more sensitive to alcohol around the menopause; for instance, if you have one glass of wine you can experience hot flashes. The worst menopauses Ive seen are in people who are drinking regularly, because that really puts stress on the liver that cant be handled when you are going through a huge transition like that. Sometimes I wonder why a person is having such a hard menopause and when I actually question them, I will find they are having a significant amount of alcohol each day. The bad estrogen is broken down in the bowels, so if you are not digesting properly, you will also have a more difficult menopause. Inadequate diet, lack of exercise, stress, emotional problems, chemical exposures (we are exposed to a huge range of chemicals now from chemtrails to pesticides concentrated in the fat of meat and dairy), lack of rest, spiritual crisis, will have a cumulative result.
Excess estrogen unbalanced by progesterone, excess insulin caused by a high carbohydrate diet and excess of these pro inflammatory substances also caused by a high carbohydrate diet and stress all work together to produce imbalance. Dr. Young says to eat six meals a day, eat protein at each meal, and cut down on refined and high glycemic index foods - like white bread, white rice, etc. which are very bad for producing sugar cravings. Eat a wide variety of colourful foods and vegetables. Eat healthy fats every day, extra virgin olive oil and flaxseed oil and fish oils. Those are the healthy fats. There is no doubt that menopause is a challenging time, and that it's a time of change. You have to make changes in your lifestyle, balance your hormones and concentrate on inner beauty and outer beauty and rejuvenation.
When you reach menopause or peri-menopause, you need to have an exercise program and it has to include weight training, as well as movement like walking and aerobic exercise. It is absolutely critical to include weight training in your exercise program and it only takes 15 minutes four times a week. It is critical for the prevention of bone loss. It also causes the single greatest rise in growth hormone, which is associated with anti-aging. So it's a great anti-aging exercise as well. When you inject growth hormone, it will cause a reversal of aging, aging of the skin, aging of the hair; it will increase muscle mass and decrease fat mass. It is used in some clinics, actually my brother has an anti-aging clinic here in Toronto called The Clinic (theclinic.ca) and he uses all of these aspects: cleansing, detoxing, growth hormone, balancing of hormones, all of the above, to achieve true anti-aging.
WEIGHT TRAINING PROGRAM
The easiest weight-training program I have found so far is the Strong Women Stay Young program. I usually do this in a workshop on menopause. It takes a day to cover it. It is a very easy program invented by a researcher at Tufts University. It shows you how to do weight training, how to design a program, and its so easy. It takes only 15 minutes four times a week and you feel really good. It slenderizes your body and it has the following beneficial effects: it increases bone mass, increases muscle mass, decreases fat mass, reduces depression, reduces blood pressure, decreases cholesterol and improves joint pain. Even people with rheumatoid arthritis can do this simple weight training. It consists of three exercises for the arms, three for the legs and two bouncing exercises. It provides the largest increase of growth hormone, the rejuvenating hormone and it improves your overall health resistance. The Strong Women Stay Young phone number to order the video is 1-888-796-6361.
If theres an emotional backlog of things you havent dealt with, that is a very significant problem at menopause. There is a strong connection between our emotions and what is happening to our hormones. It is very important for women to have some method of emotional cleansing and releasing emotions. Some recent studies published in one of the major medical journals demonstrate that writing about stressful events will actually boost your immune system by even three to four times. There are a number of different articles that show the beneficial effects of releasing stress just by writing about the event, not necessarily finding any insight, but just expressing what youre feeling on paper. Expressing your feelings in art is also beneficial.
A balance of giving and taking is important for women and often women have been giving too much. Taking is as important as giving. In Chinese medicine, that signifies that the water energy ( chi) is depleted, that is the kidney-adrenal energy, and thats why people who have given too much and not taken enough for themselves may have severe hot flashes. There's definitely a danger of being "too nice". That depresses your immune system. In a relationship, there has to be a balance between giving and taking.
During menopause, its good for women to have a time of relaxation. They need to have personal time out because it can be a very tumultuous time. Rest, rest, rest is very important for women. Most women are not resting enough. They have no time for themselves.
One of the most important things during peri-menopause and menopause is to enhance your sleep. Most women are not getting seven hours or more of sleep and that is a critical thing. A very dark room with no light coming in enhances sleep.
Tryptophan 2000 mg. can be prescribed by your doctor. If you cant get a doctor to prescribe it, you can go to a health food store and get 5-HTP. 5-hydroxytryptophan. It's good to take your calcium and magnesium at night too. It helps you sleep. I also use aromatherapy oils like lavender and some of the Young Living oils like Valour, Peace, Calming and Surrender. They are all very useful. I also use melatonin. 1 to 3 mg. at night can be very helpful. It is available in this country but only through the government. You can use it with or without tryptophan. Sleep is the most important thing for enhancing your health. In Japan, they have a rest cure, where they just go to bed for two whole weeks in a darkened room and that's it!
is a very important aspect at the time of menopause. Cleansing and fasting have been used by all cultures for rejuvenation.
Aligning with the highest purpose, having time for quiet and reflection, prayer and meditation - this kind of balance really has to be worked on.
If you don't have enough cholesterol in your diet, you will not be able to make your hormones. We need to consume some cholesterol, some good fat because cholesterol is a precursor to our hormones. I believe that low fat diets can be dangerous and they are not very helpful for weight loss or for decreasing cholesterol. The high protein diets are much more effective than low carbohydrate diets.
PROGESTERONE DECLINES MORE THAN ESTROGEN AT MENOPAUSE
When we think of menopause, we always think of estrogen declining. But actually progesterone declines more. Research by Dr. Jerilynn Prior, a professor of endocrinology at the University of British Columbia demonstrates that progesterone declines 400%, whereas estrogen only declines 50 to 100% from baseline. Progesterone is a mother hormone and will eventually turn into testosterone or estrogen.
There is massive confusion about natural progesterone. All hormones, both synthetic and natural, come from natural sources, for instance from wild yam or soy. However, it is natural only if its structure is absolutely identical to the structure of the hormones in our bodies; therefore natural progesterone will have a chemical structure that is identical to the progesterone in our own body. The progesterone most commonly prescribed by the medical profession, Provera, has a structure that doesnt resemble anything in our body, and our body doesnt really recognize it. It is very harsh on the body and can cause depression and bleeding. Extremely small chemical differences in hormones have a profound significance. For instance, if you remove one little molecular group from testosterone, it becomes estrogen.
Natural progesterone has a great side effect. It causes drowsiness and sleepiness and that can be very helpful for the insomnia around menopause. So, its usually taken at night. You can ask your doctor for prometrium. It will definitely help you sleep if you take a dose of 200-300 mg at night. For sleeping, I use L-tryptophan, a prescription amino acid that has absolutely no side effects. Its a very excellent sleep aid. These are not estrogenic herbs; they actually balance the estrogens.
If you are peri-menopausal, if you are still having periods, then you will take the natural progesterone from roughly day 12 to day 26 (day one being the first day of your period). If youre not having periods you can take it from 21 to 25 days each month. To help people remember, I have them take it for instance from the 1st to the 21st or 25th of each month, or every month they would take it at the same time and go off it at the same time.
You can start taking natural progesterone whenever you start your peri-menopause, which could be in your late 40s, whenever you see your periods changing or develop mood swings or irregular cycles, so whenever you're symptomatic.
Natural progesterone is produced in various forms. It comes in an oral form, in a vaginal suppository form, in a skin cream and in a gel. Prometrium is an oral natural progesterone available in Canada that is covered by some prescription plans. A lot of doctors know about it now and if youre on Provera, you can ask to be switched to Prometrium.
The form of progesterone that you rub into the skin is the best absorbed of all the types of progesterone. Note that when its taken on the skin, the site has to be rotated, otherwise it will become saturated and you wont be absorbing the same amount. Dr. John Lee, author of What Your Doctor Won't Tell You About the Premenopause, originally recommended that you apply it to the face, the neck, back of neck, breast, belly and the hands, but now hes changed his recommendation. Hes no longer using the breast or the belly. Hes using the palms of the hands and the soles of the feet. You use about a quarter of a teaspoon per day. You can actually get pre-measured forms and syringes so that you know the exact dose. Some pharmacists are making it up like that.
Natural progesterone comes from wild yam but wild yam creams do not contain natural progesterone. No wild yam cream that you can buy in Canada will contain natural progesterone because natural progesterone including the progesterone cream is currently is available only by prescription.
TYPES OF ESTROGEN
There are three types of estrogen - estrone, estrio l and estradiol. Of these, estrone is the most cancer causing of all the estrogens. Estriol is the least cancer causing. Estradiol is the strongest of all the estrogens.
The most commonly prescribed estrogen is made from pregnant mares urine and its called Premarin. Thats how they get the name. Pre-marin, pregnant mares urine. It has a lot of estrone and it also has horse estrogens in it which are unnatural to the human body, and it is now believed that it is the breakdown products of premarin that cause breast cancer and other problems, so that some of these products from Premarin can be very harmful.
There are many kinds of prescription hormones and one that is very common is the estrogen patch. It consists solely of estradiol; also there is Estrace, which is an oral estrogen. They at least dont contain any horse estrogens. They just contain one estrogen which is more or less bioidentical to the estrogen in the body. But estradiol is a very strong estrogen; its 12 times stronger than estrone and 80 times stronger than estriol.
Some natural practitioners have been using a preparation called Tri-estrogen, which consists of 80% estriol, 10% estrone and 10% estradiol. Dr. Jonathan Wright was the first person who started this Tri-estrogen - this triple estrogen.
Compounding pharmacies will make up the special estrogens for you. These estrogens are very effective in controlling symptoms of those women who need to take them. Its not as strong as some of the other preparations but you can get it in a pill form, a capsule form, and a cream form.
I dont routinely prescribe estrogens. I routinely prescribe natural progesterone because I find it takes care of a lot of the problems of menopause. I dont prescribe estrogens unless the person is having a very difficult time with menopause, or has had an early menopause at age 30 or 35 or something like that.
Dr. John Lee advised a five-day gap in the treatment to give a break to the receptors. You stop both the estrogen and the progesterone. Sometimes when people are in the midst of a very severe menopause, I will have them go every day of the month for a very short period of time and then cut back. The body is cyclical. There is a big trend now to prescribe premarin and Provera every day of the month, but there is very little evidence on the safety of that regimen. Even in conventional journals, they will tell you that there are no studies on this everyday regimen with low doses of provera. Its really an experiment.
Vaginal estrogen is very useful for those who have vaginal dryness and dont want to take pills. Estriol is the most effective for this particular vaginal dryness and estriol in a vaginal cream is a powerful easy way to deal with vaginal dryness. There are also natural remedies, like chasteberry, which is also very good for vaginal dryness, and even if you take a prescription of vaginal estrogen, it will not increase the blood levels of estrogen.
Look at your lifestyle and natural methods first, but if everything else fails, there is definitely a role to taking natural estrogens, along with progesterone, and sometimes it is very effective. I had a patient who was having incapacitating hot flashes - twelve to fifteen a night. She was up all night and she was trying to work during the day. She had a very good lifestyle, lots of exercise, a good diet, a good attitude; but she probably was too stressed, but thats quite a common thing. She tried Remifemin, which is black cohosh extract and a number of other things but they didnt work. So we put her on an estrogen skin cream and a progesterone orally and she is doing very well. She feels like a new person because shes sleeping every night. Thats a big change. Were planning short term, maybe six months for the estrogen and progesterone together, and then continue with the progesterone alone.
SIDE-EFFECTS OF ESTROGEN
Estrogen does relieve hot flashes and night sweats and vaginal dryness. It somewhat improves the cholesterol profile. All of these things can be done naturally without estrogen. Estrogen can be helpful for urinary problems, urethral problems, but you can also get a little vaginal ring or you can just use local estrogen right in the vagina to help with the vaginal dryness. It helps bone loss but as soon as you discontinue the estrogen, you lose all the bone that you gained. It does increase skin thickness. It has never been proven to decrease the risk of Alzheimer's, stroke, osteoarthritis or colon cancer. It does have a lot of possible negative side effects. It definitely increases uterine cancer by eight to ten times, and that is why it was originally combined with the synthetic progesterone, known as Provera. That has been proven without any shadow of a doubt. It increases the risk of breast cancer by a small amount, depending on which study you are using. It definitely increases gall bladder surgery, fibroid growth, blood clots in the leg, known as thrombophlebitis, endometriosis and lupus. Also, a long-term study shows that if you take estrogen for more than six years, it increases the risk of fatal ovarian cancer. It may also make asthma worse, because there are some estrogen receptors in the lungs and some people taking Premarin do notice an increase in asthma and respiratory problems.
HORMONE REPLACEMENT THERAPY
It may surprise you to know that only 50% of women develop heart disease and only 25% of women develop osteoporosis, yet at the present time it is recommended that all women go on hormones for ten years! The medical profession is becoming much less dogmatic about whether this is absolutely necessary because the research is becoming less and less convincing with respect to heart disease. Its become questionable whether hormones do prevent heart disease. With regard to bone loss, there are a lot of good natural ways to prevent bone loss.
Vitamin E reduces the risk of heart disease as much as estrogen. In a famous study thats always quoted, the nurses study, they found it reduces heart disease by 60%. Vitamin E reduces recurrent heart disease and recurrent heart attacks. Every man should take Vitamins E and C for prevention of heart disease.
The cardiologist, Dr. Steven Sinatra, says that heart attack is preceded by a great sense of alienation and separation in the world. We never link love and the heart and separation with regard to heart disease. It is definitely linked. If you do develop heart disease, you can go for chelation therapy. Many physicians in this province now practice chelation therapy. There are a huge number of chelation clinics.
Black Cohosh extract has been used widely in Europe for over 40 years and is very well tested for hot flashes and vaginal dryness. It is one of the most studied of the natural remedies for menopause. The brand name that was studied was Remifemin. Its a standardized root extract of black cohosh. You only have to take one tablet twice a day. They lowered the dose, which is good because it is fairly expensive. It improves all menopausal symptoms. It has a good safety record, and it has an estrogenic effect on the vagina, so it helps with vaginal dryness the same as Premarin. It has a very similar effect. Another great thing is that it is totally natural. I usually combine it with natural progesterone. Black cohosh is not estrogenic, and does not increase your estrogen level. Its an excellent herb, but it does not work for everyone.
Another one that you can get in the health food store is red clover extract, which is is high in plant estrogens.
Dr. Tori Hudson, head of a clinic at the Naturopathic Clinic in Portland for women is using licorice root which helps the adrenal glands, burdock which helps the liver, dong quai and wild yam, which is actually just a soothing herb. She did a study using a combination of two parts licorice, two parts burdock, two parts dong quai, one part wild yam and one part motherwort. That will get rid of any hot flashes. You can get it in a health food store already made up. Whenever Dr. Hudson uses a herb like dong quai or black cohosh, she uses another herb that will balance it like licorice and wild yam, so that it will have a progesterone-like effect.
Dong quai and Panax ginseng are Chinese herbs and it is recommended that dong quai be taken for four weeks followed by panax ginseng for two weeks. Panax ginseng can make you more anxious and more irritable if you are prone to high blood pressure or anxiety or irritability, so you have to use them cautiously. Chasteberry is very good for vaginal dryness. It takes a long time to work so you have to take it on a long-term basis. Its an excellent herb. Motherwort is great for palpitations at night. Its an easy herb to grow. It belongs to the mint family.
Soy is another plant estrogen that can be used for hot flashes and menopausal symptoms. Soy can lower cholesterol and reduce the risk of breast cancer. It contains very weak estrogens. There is a synthetic soy derivative that has been used for bone loss and there have been 100 published studies showing that it is helpful. I have a problem with it because there was a large study which showed that it affected the blood count! They took soy derivative and they altered it in order to patent it. Every time you alter a molecule, it has effects. I only advise fermented organic soy, because that seems to have the best health effect. Often people cannot tolerate soy and if we eat too many soy capsules that could become a problem. It can affect your thyroid, and it can have a negative effect.
A substitute for soy that is very, very interesting is flaxseed. One tablespoon of ground organic flaxseed, is equal to about one serving of soy. There is actually a cookbook to that effect: Estrogen the Natural Way by Nina Chandler.
Important treatments for bone loss are natural progesterone, weight training, weight bearing exercises, a high quality calcium-magnesium supplement and improving digestion. I usually I tell people to rotate through the different calcium and magnesium supplements, especially to emphasize the calcium-magnesium citrates because they appear to be better absorbed. The carbonates are the worst absorbed. If you are losing bone, its recommended to test hormone levels. If you are not taking hormones and want to know where your bones are at, you can have a screening test known as a heel ultrasound. You just put your heel in a little machine and it will tell you whether you have lost bone. You can also do a bone scan which is about a seventh of a chest X-ray. That is very valuable. If you start calcium supplementation at age 35, you can maintain your bone density better.
There was a large very well designed study of 98 women. Half took calcium, half didn't. Even though they took a lousy form of calcium, calcium carbonate, they still maintained their bone mass better than those who didnt. So that indicates that at age 35 we must start using calcium and magnesium. Calcium citrate, calcium citrate maleate is the best form of calcium. Trace minerals as well as magnesium are very important. If you take 1,000 mg. of calcium, you always take half the quantity (500 mg). of magnesium.
COMPOUNDING PHARMACISTS in the Toronto area:
Hoopers Pharmacy on Wellesley, Smiths Pharmacy on Yonge, Snowdon Pharmacy on Bloor, Markies Pharmacy on Bay, and York Downs Pharmacy. So, if you need to discuss natural hormones or to have them compounded, you may contact these pharmacies.
Carolyn DeMarco's book Doctor DeMarco Answers Your Questions is available at Consumer Health Organization. Please call 416-490-0986. Dr. DeMarco's website is: www.demarcomd.com