By Joseph L. Mayo, MD, FACOG
Menopause is a normal transition preceded by hormone changes during the late premenopause and perimenopause years. Late premenopause refers to the period between the ages of 35 to 40, a time when some women begin to experience the first signs of changing hormone levels. However, most women experience the first signs of approaching menopause between the ages of 40 and 51, a period known as perimenopause. The actual onset of menopause, which is characterized by a cease of menstruation for one year, occurs in most women by age 50 to 51, after which women are considered postmenopausal.
Over one-third of women in the United States are experiencing or have been through menopause, many of whom have endured symptoms of hormonal changes. The most common symptoms are hot flashes, which are estimated to occur in 6% to 63% of premenopausal women; 28% to 65% of perimenopausal women; and 93% of women in their first two postmenopausal years. The pattern and intensity of symptoms may vary greatly, and many women are also challenged with a barrage of other hormone-related complaints (Table 1).
Table 1. Signs and symptoms of the menopause transition:
– Hot flushes/night sweats
– Irregular menstrual bleeding
– Decreased vaginal lubrication
– Painful intercourse
– Depression and mood swings
– Memory loss
– Sleep disturbances
– Cold hands and feet
– Weight gain
– Urinary incontinence
– Loss of libido
TRANSITIONAL HORMONE CHANGES
During the ten to fifteen years before menopause, estrogen and progesterone levels begin fluctuating and can become out of balance with each other. In the last year preceding the onset of menopause, estrogen levels decrease very rapidly. This decline in estrogen, along with other sex hormones, prompts the onset of menopause.
Influences on Women’s Health
The changes in hormone levels that occur during the menopause transition may cause more than undesirable symptoms; they may also contribute to disease risk and functional disorders. Women who are already at an increased risk because of genetics, illness, or poor dietary and lifestyle choices should be especially concerned.
Dysfunctional Uterine Bleeding
Dysfunctional uterine bleeding (DUB) is a functional problem that commonly occurs during perimenopause, with greater than 25% of cases in women over age 40. DUB is characterized by irregular menstrual bleeding that may be more or less frequent, lighter or heavier, shorter or longer in duration, or spotting between menstrual cycles. It is important for women with irregular menstrual bleeding to have a thorough medical assessment. Other types of irregular menstrual bleeding may be associated with a serious medical condition.
Osteoporosis and Heart Disease
Heart disease and osteoporosis are very prevalent in postmenopausal women. Both of these diseases are strongly linked to the decline in hormone levels associated with menopause. Unhealthy dietary and lifestyle factors such as inadequate calcium and vitamin D intake, lack of exercise, excessive alcohol and caffeine consumption, and smoking also increase disease risk.
NUTRITIONAL SUPPORT FOR WOMEN’S HEALTH
Nutritional support for women from premenopause and beyond should include natural ways to support hormone balance, as well as ways to help reduce the risk of osteoporosis and cardiovascular disease.
Soy isoflavones are plant compounds that have weak estrogenic action in the body. According to research, they appear to protect against menopausal symptoms, as well as osteoporosis and cardiovascular disease. For those patients who may be allergic to soy, isoflavones are also found in the herbs red clover and kudzu root.
It is well known that adequate calcium intake helps to prevent the excessive bone loss that is associated with osteoporosis. In addition to calcium, vitamin D and minerals such as magnesium and boron are recognized as important nutrients in maintaining bone strength throughout the menopausal years.
Vitamins C and E:
Vitamins C and E are important antioxidants that support cardiovascular health and immune function. Some women may need higher levels of these vitamins due to lifestyle factors or certain health issues.
HERBAL SUPPORT FOR THE MENOPAUSE TRANSITION
The systems of complementary medicine are well documented, with the use of herbs in medical practice dating back centuries. Today, the healing properties of herbs are actively researched, and scientists continue to validate their historical uses.
Black cohosh is a time-honored herb that was first introduced to gynecology as early as the 18th century. Modern research supports its use in the management of peri- and postmenopausal complaints. Popular in Germany, it has also been approved by German health authorities to be used for irregular menstruation, premenstrual discomfort, and menopausal hot flashes.
Chasteberry has a long history of use as a women’s remedy, with the first medicinal accounts recorded by Hippocrates in the 4th century B.C. Today, chasteberry is widely used and accepted as a treatment for female complaints such as menopause, PMS, abnormal menstrual rhythm, water retention, and painful breast swelling.
Dandelion and Stinging Nettle:
Stinging nettle has been used since ancient times as both a food and medicinal plant for a wide spectrum of ailments, including premenstrual water retention and for provoking menses. Similar to stinging nettle, dandelion (Taraxacum officinale) has a long history of use as a natural diuretic. Due to the overlapping effects, these two plants may be more effective when used in combination.
Valerian, Motherwort, and Lemon Balm:
Addiitonal herbs to consider are those with mild sedative activity. Women who experience insomnia, tension, or anxiety with menopause may find some relief with herbs such as valerian root, lemon balm, or motherwort.
By Joseph L. Mayo, MD, FACOG