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MENOPAUSE: WHAT'S A WOMAN TO DO? PART 3

Updated 7/24/2013   


         Dr. Bernard Presser D.C.

5696 Magnolia Woods Drive

Memphis, TN 38134



 

If you have any questions, please contact us at 901-417-7905

 More articles coming soon.

 


Many doctors and women have recently changed their opinions of hormone replacement therapy (HRT) to treat menopausal symptoms.  Many women have discontinued using HRT because of concern about side effects (unwanted effects) like breast cancer as well as the failure of HRT to protect them from heart disease, stroke, and other banes.  Many alternatives to HRT are now being promoted, including "bio-identical hormones" such as progesterone creams.

BIO-IDENTICAL HORMONES

Bio-identical hormones are made from beta-sitosterol, extracted from soybeans, or from diosgenin, derived from wild yam.  These extracts are converted in a laboratory to the "same" chemical structure as hormones made in the body.  They may resemble human hormones, but they are not human hormones, in fact they are far from it.  Forms of estrogen (estriol, estrone, and estradiol), progesterone, testosterone, and DHEA may be manufactured this way for bio-identical hormone replacement therapy (BHRT).  This therapy is often called "natural", but in reality, it is not natural since the products are manufactured by a compounding pharmacy.  True, they originate from plant sources and they are not the "twisted, misshapen-but patentable" hormones usually given to women, and they are available without preservatives, adhesives, dyes, binders, and fillers.  Some women who switch from "horse estrogens" (Premarin) and progestin (synthetic progesterone) to BHRT say they feel better.  BHRT is available in creams, gels, sublingual and buccal preparations, transdermal patches, oral tablets, pellet implants, injectable products, and suppositories.  But they are not foods or herbs.  They are hormone drugs.

These drugs have not been tested thoroughly for safety and efficacy.  In some instances, compounders may lack sufficient controls (equipment, training, testing, or facilities) to ensure product quality or to compound difficult products.  Some pharmacies make unsubstantiated claims about their BHRT products which are made from bulk powdered drug substances of unknown quality from "sometimes questionable sources".  An FDA analysis in 2001 found that 34% of compounded hormones flunked standard quality tests and 90% failed potency tests.  So far, there's precious little scientific study on BHRT compared to conventional HRT, and there is no real evidence yet that they work better or that they're safe.  Without head-to-head comparison studies, it "is not possible to state definitely that bioidentical HRT is safer."  Research is inadequate to state with certainty that the increased risk of breast cancer, heart disease, blood clots, and strokes is any less for BHRT than other kinds of hormones.  Some research has implicated bio-identical estradiol as a risk for cardiovascular disease.  "The use of HRT, whether bio-identical or not, should be used only after non-hormonal therapies have been shown to be inadequate to address quality of life issues".  No hormone therapy can be considered completely safe.  There is always some risk.  Only when every other therapy has been attempted and severe symptoms exist or a radical hysterectomy was performed should such treatment be considered.  Granted, BHRT may be better, even somewhat safer, than conventional HRT-particularly if it is used in small doses-but caution should not be thrown to the wind.  If they are used, short term use (less than 5 years) is considered less risky than longer periods.

For example, estradiol, the most active form of estrogen, is normally metabolized into less active metabolites, particularly estriol, a weaker form of estrogen.  But there are "a small but significant proportion" of women who do not metabolize their estradiol into estriol.  This increases the risk for cancer such as breast cancer.  Primarily it is the liver that metabolizes or re-arranges hormones.  Excess toxic load can compromise the liver‘s ability to perform this function, raising the question of whether estrogen is really a cause of cancer, or if an over-stressed liver is the real culprit because it cannot convert hormones properly.  Nevertheless, taking estradiol as a drug can place more strain on an already over-taxed liver.  In her book, The Sexy Years, Suzanne Somers promotes the use of a hefty dose of estradiol, about 4 times the physiologic range.  Not only could this stress the liver, but it alters the ratio and appropriate adjustments of hormones that naturally should occur.

Jonathan Wright, MD, says that steroid hormones such as estriol, estradiol, and DHEA "should NOT be taken orally."  According to one study, he says, orally taking only 1 to 2 milligrams of low-potency estrogen increased the relative risk of developing endometrial cancer.  Instead, he recommends "the more physiologic transdermal route"-through the skin.  Why administering a hormone through the skin is more "physiologic" is not explained.  However, it‘s true that doctors generally prescribe larger than physiologic doses of hormones-that is, they give amounts that are much higher than a woman would normally make herself.  Thus, an important factor regarding the safety of bio-identical hormones is the dose.  Studies on conventional HRT show less risk from very low doses rather than commonly-prescribed high doses.  Another consideration is the type of estrogens (estrone, estradiol, estriol) used and the proportion of each.  Conventional synthetic progestins combined with estrogens can cause many side effects; bio-identical progesterone appears to be safer.  Finally, many researchers contend that estrogen should be administered, not continuously, but only part of each month.  One debate is whether or not women getting BHRT should have a period every month for safety.  Some doctors recommend high doses that bring on menstrual bleeding.  Other doctors prescribe estrogens and progesterone in a cyclic fashion-enough to improve symptoms, but not enough to cause a period every month.  The low quantities of hormones are "carefully monitored for safety".  Since research "links (among other things) simple exposure to higher doses of estrogens to increased estrogen-related cancer risk," and as "this is even true with bio-identical estrogens," low doses are safer.  Actually, "correct" dose, proportions, and timing are all important for safety.  Low doses of estrogens AND progesterone reduce (but don't eliminate) risks.  Inducing monthly menstrual bleeding with higher doses of progesterone doesn't have any additional benefit in lowering cancer risk.  If hormones are used, they should be in amounts the body would naturally produce, in the pattern and time frame it naturally follows, and administered according to the individual woman's biochemistry.  Sound complicated?  Yup.

 BHRT can be customized-individualized with stronger or weaker units-based, usually, on saliva tests.  The custom-designed treatment recipes can be adjusted "as a woman‘s needs change over time", but since saliva tests may not be meaningful, and less so when a woman is taking hormones, the adjustments would have to be based on symptoms or health issues.  BHRT is thought to be metabolized differently than conventional HRT.  The hypothesis is that conventional hormones act like environmental toxins to the genetic material within cells that have hormone receptors.  Bio-identical hormones are structurally closer to natural hormones and have a shorter half-life, yet they are still not exactly the same as those made and regulated by the body.  Either or both may be toxic to estrogen sensitive tissues, for example, or may alter binding of other hormones to those receptors or alter the liver's metabolism of carcinogens.  Maybe BHRT has less of a negative effect.  Maybe not.  

Bio-identical progesterone appears to have fewer adverse effects on the cardiovascular system than synthetic progestins.  A French study found that transdermal bio-identical estradiol plus oral micronized progesterone was not associated with an increased risk of breast cancer, whereas transdermal conventional estradiol with synthetic progestins did increase risk.  Still, bio-identical hormones may not come without risks for the breast and cardiovascular system.  Besides, other strategies are known to reduce the risk of heart disease, breast cancer, osteoporosis, dementia, and other problems associated with aging and menopause.  Tori Hudson, ND, warns: "It should also be stated that practitioners who are prescribing bio-identical hormones should not be naive or blindly assume that bio-identical hormones are without risks while making the accusation that all other hormones are dangerous and unsafe.  The scientific research is just not available to support this kind of perspective."  She advises practitioners who prescribe BHRT to re-evaluate each patient's hormone regimen regularly (at least yearly) to establish the lowest possible dose to achieve goals and minimize the risks.  Use the lowest dose possible for the shortest amount of time needed.  Many women will not need, or want, hormone therapy-even BHRT.  Dietary improvements, whole-food supplements, herbs, exercise, achieving emotional health, relaxation techniques, and other lifestyle aids all have substantial impacts on hormonal balance, the cardiovascular system, immune system, bones, brain, and all aspects of health. i

Creams or gels that are rubbed into the skin are called "natural" transdermal progesterone, and are used to alleviate hot flashes and night sweats, improve vitality, and relieve other symptoms such as breast tenderness, low libido, and insomnia.  Claims about the creams' ability to prevent bone loss and increase bone-mineral density have not been substantiated.  Other claims include relief of fluid retention or bloating, protection from cancer, improved breakdown of fat into energy, and easing of anxiety, irritability and depression.  These, too, have not been proved.  Clinical trials have yielded mixed results-sometimes hot flashes and night sweats are eased and sometimes they're not.  There are some indications of a small increased risk of breast cancer.

The creams are usually made from wild yam or soy.  The phytoestrogens in wild yam or soy are not the same as the hormone progesterone, but are used to manufacture steroid hormones.  A series of laboratory manipulations must take place to produce something with the same molecular structure as progesterone.  That makes it a drug.  John R. Lee, M.D., recommended rub-on creams or gels because, when taken orally, progesterone is destroyed by the liver-it's not a food, it's simply a drug.  Analysis of saliva samples from women using wild yam cream or tablets without added hormones indicated their progesterone and DHEA levels and activities were no different from those of untreated women.  A 2001 clinical trial found that a wild yam cream with hormones added had little effect on menopausal symptoms; an increase in saliva progesterone was not detected.  Even when hormones are increased in saliva, they may be "paradoxical" and not reflect what is circulating in the body.  Other studies detected slight increases in blood levels of progesterone-proving only that the progesterone in the creams can be absorbed into the bloodstream.  Yet absorption is highly individual and varies from woman to woman.  Some women end up with levels in the blood that are just as high as those that result from taking synthetic progestin pills.  Even high doses of rub-on creams may not increase circulating blood progesterone enough to cause any favorable changes in the endometrium.  Women in a 2005 study preferred progesterone cream over standard hormone therapy, though those using the cream had as much vaginal spotting as women using standard hormone drugs.  Still, the creams appear to be safer-there‘s no evidence of excess growth of uterine tissues which may indicate cancer risk.  A 2004 study indicated a "modest" bone-sparing effect, but when soymilk was added, a negative interaction resulted in greater bone loss than either treatment alone.  Other studies have found no evidence that the creams protect bones.  One study found no effect on bone density after an entire year of use.  According a study on cancer risk, "natural" progesterone and synthetic progestins both have similar action in the body.

Progesterone creams can cause side effects (unwanted effects).  Dr. John Lee recommended that premenopausal women take a break each month from the cream "to allow menstrual periods to occur on a regular basis and to refresh progesterone receptors".  If a woman doesn't take a break, her cell receptors get the message that there's too much progesterone in the system, and "they will shut down".  This is not a response to a food or herb; this is an adverse effect from a drug, a hormone not being regulated by the body.  Many health professionals say there isn't anything progesterone creams can do that whole-food supplements and diet can't accomplish by themselves.  Real foods and herbs provide raw materials that the body recognizes from which it may produce and regulate its own hormones.  Dr. Lee admitted that the cream "can't be used as a precursor to other hormones".  Dr. Ellen Grant says: "There is no single magic cure (or rub-on-cream) for the man-defined ‘disease' of the menopause".  The best way to approach menopause, she contends, is to observe simple rules that promote good health such as a good diet, food supplements, avoiding tobacco and other toxins, and getting plenty of fresh air, sunshine, and exercise.

Some progesterone creams contain synthetic progestin, not from wild yam or soy.  Some contain diosgenin, a chemical made from wild yam that can't be absorbed by the skin.  Some creams may be adulterated with talc or other look-alikes.  One study showed only 1 out of 13 products raised progesterone levels.  Several creams didn't even contain the progesterone claimed on their labels.  Many contain parabens as preservatives-chemicals that may cause cancer.  It is notable that yam (Dioscorea)-not sweet potatoes called "yams"-has been traditionally used to treat menopausal symptoms.  One study found that eating real, whole yams resulted in increases in blood concentrations of estrone (26%), sex hormone binding globulin (.5%), and estradiol (27%).  Two-thirds of women's staple food was replaced with yam for 30 days-that's a lot of yam, but it did improve hormone status.  The yam didn't contain hormones, just building materials from which hormones could be made. ii

DHEA (dehydroepiandrosterone) is an adrenal hormone that can be converted to estrogen and testosterone.  When bodily levels start declining, there may be increased body fat, decreased bone mass, memory loss, higher cholesterol, and reduced libido.  Studies are trying to ascertain if giving a DHEA drug to postmenopausal women will help hormone levels or menopausal symptoms.  One study showed increases in progesterone, estrone, estradiol, and testosterone, along with decreases in follicle-stimulating hormone and luteinizing hormone.  Symptoms improved also.  Still, additional studies are needed to determine safety.  Long-term use may lead to liver damage and certain cancers.  Proponents claim DHEA "supplements" have anti-aging effects.  Critics say that's nonsense.  Hormones are designed for complex biological communications, so the opportunity for garbled or distorted messages is very great and the potential for harm is certainly present.  Hormones are not dietary supplements.  You can't eat human hormones in foods or herbs.  You can support adrenal function nutritionally.

Testosterone has been used for postmenopausal women to improve sexual function-desire, arousal, and orgasmic response.  Testosterone, a so-called "male" hormone, is made in tiny amounts by women.  If used, the North American Menopause Society recommends topical gels or creams over oral products and the lowest possible dose for the shortest time that meets treatment goals.  Laboratory testing of testosterone levels should not be used to diagnose testosterone insufficiency or to monitor for excessive levels.  Lab tests "cannot accurately detect testosterone concentrations at the low values typically found in postmenopausal women."  Side effects such as facial hair growth and acne are common. iii

Hormone therapy-bio-identical or not-involves the use of extremely powerful drugs.  Bio-identical hormones may be closer to imitating the structure of a woman's hormones, but they are still imitations and cannot be regulated and monitored by the body like hormones that are produced by the body.

SALIVA TESTS

Human hormones function within a complex network of other hormones and metabolic mediators.  The hormone "dance" in a woman‘s body requires a balanced orchestration of all these constantly modulating substances.  Hormone levels differ between individuals; what is normal for one is not necessarily normal for another.  To interpret a hormone's level, not only its absolute level must be considered, but also its relative ratios with other hormones including not only estrogens, progesterone, and testosterone, but thyroid and adrenal hormones as well as others.  We may hear about estrogen dominance in women with signs such as PMS, irregular and heavy menses (before menopause), breast swelling (sensitive to the touch), fibrocystic breast tissue, ovarian fibroids, uterine fibroids, craving sweets, weight gain and overall increase in body fat, acne, fluid retention, sleep disturbances and insomnia.  Signs of estrogen insufficiency are said to include hot flashes, night sweats, lethargy, fatigue, memory loss, loss of libido, vaginal dryness, vaginal mucosal atrophy, tension, irritability, anxiety, headaches, joint pains, stiffness, weight gain, thin hair, and aging skin.  However, any of these and other symptoms can indicate low levels of estrogens, progesterone, androgens, and/or adrenal hormones, or elevated levels of some and lowered levels of others, and even elevated and lowered levels of the same hormones.  The point is that the delicate dance of hormones and numerous hormone metabolites is complex, occurring with many and varied steps, all individualized to the woman.  Steps can get out of sync with the music if there is some disruption or deficiency.  The journey through menopause is a chaotic, capricious dance with steps and music unceasingly fluctuating.  Measuring the level of any given hormone(s) at any given time may not reflect the true or whole picture.  Test results may be meaningless.  Still, alternative practitioners often use saliva hormone assays.  Why?

It's claimed that results of serum or plasma blood tests for steroid hormones are "essentially irrelevant".  Steroid hormones like estrogens, progesterone, testosterone, cortisol, DHEA, and others are lipophilic (fat-loving) and are not soluble in blood serum.  Hormones carry their message to cells by leaving the blood flow at capillaries to bond with cellular hormone receptors in order to convey their message to the cells.  These are "free" hormones.  When eventually they circulate through the liver, they become protein-bound (enveloped by specific globulins or albumin), which impedes their bioavailability and makes them water soluble-facilitating their excretion in the urine.  According to David Zava, PhD, 95% to 99% of the steroids in blood are bound up by proteins. "Measuring the concentration of these non-bioavailable forms in urine or serum is irrelevant since it provides no clue as to the concentration of the more clinically significant ‘free' (bioavailable) hormone in the blood stream."  When circulating through the saliva glands, the ‘free' non-protein-bound steroid hormone is believed to diffuse easily from the capillaries into the saliva gland and then into saliva.  Protein-bound, non-bioavailable hormones do not pass into or through the saliva gland.  So, saliva testing is thought to be superior to serum or urine testing in measuring bioavailable hormone levels.  It's claimed that saliva testing helps determine optimal dosages of supplemented steroid hormones, something that serum testing cannot do.  Such claims have yet to be verified.  Several studies have indicated that topical progesterone supplementation increases tissue levels of progesterone without a parallel increase in serum levels.  But no one is exactly sure what this means.

Advantages to using saliva for testing include:  The ease and simplicity of collecting saliva any place or time in more stress-free conditions.  Steroid hormones are stable in saliva, allowing for collection and shipment at room temperature by inexpensive couriers.  Disadvantages involve:  Greater technical challenges in testing saliva than testing blood, limiting the number of laboratories that are capable of performing the tests.  Labs must have the technical expertise to either create their own tests or modify commercial test kits.  Anything taken into the mouth-food, drinks, gum, drugs, toothpaste, mouthwash-just before collecting saliva can interfere with test results or cause a transient shift in hormone levels.  Even cottons used for saliva collection may contain substances that interfere with some tests.  Saliva can be contaminated inadvertently during collection with topical hormones present on the hands or lips.  Labs are not subject to proficiency testing for saliva, only for serum-competency and accuracy of each lab must be determined.  Saliva tests may not be nearly as accurate as claimed.

Actually, the North American Menopause Society suggests that the vaginal pH be checked to assess estrogen status.  If pH is less than 4.5, then the woman has adequate estrogenization.  This may be far easier and more indicative of estrogen status than blood or saliva tests. iv

BEST BETS

Before resorting to hormone drugs or seeking one magic bullet, the best bets to ease menopausal symptoms and improve health are lifestyle changes.  These include dietary adjustments, whole-food supplements, whole herbs, losing weight (if needed), regular exercise, more or better sleep, stopping smoking, relaxation techniques like deep breathing, meditation, and other reasonable, healthful therapies.

Nutritional attention should be given to the adrenal glands, a primary source of estrogen when the ovaries slow down their production.  If the adrenals are stressed and functioning poorly before menopause, they certainly can't produce the needed estrogen when menopause begins.  When cortisol, an adrenal stress hormone, is high, the brain is less sensitive to estrogens.  That‘s why a postmenopausal woman with reasonable amounts of estrogen can get hot flashes and other symptoms when she is under stress and her cortisol levels rise.  The adrenals also produce aldosterone, androstenedione, testosterone, hydrocortisone, DHEA, and other hormones, all of which are participants in the hormone dance.  The adrenals require plenty of vitamin C complex (the need for which skyrockets during periods of stress); pantothenic acid, vitamin B6, other B vitamins; minerals such as potassium, magnesium, zinc, manganese, and copper; essential fatty acids (including omega-3s); and other nutrients.  Bovine adrenal glandulars are supportive of the body's needs.  Herbs such as stinging nettle, Panax ginseng, and Ahswagandha may assist.  Ground flaxseeds and evening primrose oil or black currant seed oil may help the adrenals produce estrogens.  Sea vegetables, green vegetables, and yellow-orange vegetables and fruits provide minerals used during stress.

Complications in thyroid gland function can be involved in menopausal symptoms.  Under-functioning thyroid symptoms include osteoporosis, high cholesterol, tiredness, weight gain, dry skin, fluid retention, brittle hair or hair loss, menstrual irregularities, impaired memory, puffiness around the eyes, and constipation.  Overactive thyroid can result in nervousness, irritability, heart palpitations, hot flashes, fatigue, decreased menstrual flow and sleep disturbances.  All endocrine glands and their hormones affect all other endocrine glands and their hormones.  So an overactive or underactive thyroid can affect levels of estrogen and progesterone.  Iodine, selenium, other minerals, essential fatty acids, and vitamins A, B, and C complexes are among the nutrients needed for thyroid function.  Just supplying protein-bound iodine often eases hot flashes and other symptoms.

Low blood sugar (hypoglycemia), often brought on by regular consumption of refined carbohydrates (sweets, white flour products, artificial sweeteners, and the like), can cause a frequent feeling of "running out of fuel".  A significant drop in blood sugar can cause shaking, sweating, anxiety, headache, nausea, weakness, fatigue, and irritability, even sleeplessness due to a drop in blood sugar during the night.  Chromium, zinc, manganese, B complex, and other supportive nutrients may be required as well as a diet of whole, natural, unrefined foods.

When the body is overrun by persistent or potent toxins, the liver and other detoxification tissues are challenged to do more than they can handle.  The liver must convert estrogens and other hormones into the most beneficial forms and ready them for excretion when required, but cannot do this optimally with a heavy toxic load.  Toxic buildup can lead to excess fatigue, food and/or chemical allergies and intolerances, immune compromises, headaches, and other problems.  Some toxins are hormone disruptors and have a molecular structure very similar to estrogen.  Avoiding toxins whenever possible and engaging in a detoxification program may relieve many symptoms related to menopause.  A food elimination diet may uncover food allergies or intolerances.

It is helpful to avoid products containing high amounts of refined sugars or refined flours, fried foods, altered fats (like trans fats), and any other stripped, over-processed, depleted, mangled, and otherwise tampered-with or industrialized nonfoods.  Some women need to avoid caffeine, heavy spices, chocolate, or alcohol for relief of hot flashes.  The diet should contain whole, natural foods-organic whenever possible-which are more nutrient dense than conventionally grown foods.  Since steroid hormones are made from cholesterol, women need to include animal-source foods in their diet to feel well.  Some women find that, in addition, an abundance of fresh plant foods works best for them.

Calcium, magnesium, vitamins A, C (with flavonoids and tyrosinase intact), E (including selenium), and B (especially B6, folic acid, B12) complexes are among the nutrients that may be needed more than usual.  PABA (para-aminobenzoic acid) in B complex may potentiate hormones.  B6 assists symptoms such as mood swings, depression, anxiety, edema, bloating, and skin eruptions.  Meats, seafood, whole grains, nuts, seeds, many fruits and vegetables, and beans all contain B vitamins.  Hesperidin, a flavonoid in vitamin C complex, can relieve hot flashes and is particularly rich in citrus fruits.  Vitamin E complex may relieve vaginal dryness, hot flashes, breast tenderness and other symptoms.  Unrefined vegetables oils, avocado, asparagus, egg yolks, lima beans, peas, sweet potatoes, dark leafy greens, nuts, seeds, and whole grains are good sources.  Calcium is known to help prevent bone loss, but other nutrients are also needed for bone protection such as boron, silica, manganese, vitamin D complex, vitamin C complex, magnesium, and others.  Nettles (high in calcium and a fair amount of magnesium) mixed with horsetail, which contains silica, can be a potent bone strengthener.  Dairy products (certified grade A raw, if possible), dark leafy greens, and beans also contain plenty of calcium.  Sea vegetables such as dulse, kelp, and wakame contain all trace minerals.  Bone meal from pasture-raised animals is excellent.

Magnesium not only has a calming effect, it also helps bones absorb calcium and helps muscles (including the heart) to relax.  Nuts, kelp, escarole, kale, other vegetables, and whole grains pack magnesium.  Increasing boron intake raises estrogen levels in postmenopausal women while, at the same time, decreasing loss of calcium and magnesium in the urine.  Boron inhibits the decline in estrogen and testosterone levels and may prompt the body to produce more of its own estrogen.  Low boron levels have been linked with an increased risk of heart disease and a decline in cognitive function.  Almonds, peaches, plums, figs, raisins, asparagus, tomatoes, cabbage, apples, and strawberries are among good sources of boron.  Chromium, part of the glucose tolerance factor in foods (meats, mushrooms, whole grains), and zinc (meats, shellfish, spinach, other vegetables) are important to blood sugar processing.  Zinc is also important for bone formation, slowing bone loss, and aiding vitamin D absorption.  Essential fatty acids, especially the oft-deficient omega-3s, may help menopausal symptoms and assist in preventing breast cancer, osteoporosis, and cardiovascular disease.  Small, deep-ocean fatty fish, flaxseeds, and walnuts are excellent sources of omega-3s.  Oil from rice bran or germ helped improve menopausal symptoms (hot flashes, joint pain, muscle pain, weakness, headaches, insomnia, nervousness, and depression) in 85% of woman tested.  Evening primrose or black currant seed oil (sources of gamma-linolenic acid or GLA) may alleviate many menopausal symptoms.  Various fruits and vegetables provide plant nutrients including phytoestrogens.  Pomegranate seeds contain an estrogen-like compound.  Like all phytoestrogens or other food factors, their function is to provide what is needed to increase and balance hormone production, not replace it.

The physical and psychological benefits of exercise include reductions in the risk or incidence of cardiovascular disease, hip fracture, and breast cancer; an increase in bone mineral density; lowered body fat; improved energy; lifted depression; eased irritability; and more.  Physically active women have fewer and less severe hot flashes and night sweats-sometimes more than 50% less--than their sedentary counterparts.  But overly strenuous exercise may trigger hot flashes in some women.  The idea is to exercise frequently at a gradually more intense level.  Exercise enhances DHEA levels.  Even ballroom dancing and tennis improve symptoms, although the most benefits come from a combination of aerobic, endurance-oriented and strength-training exercise.

Mind-body approaches can be used to reduce the stress response, reduce stress hormones, and help balance the autonomic nervous system.  Women practicing relaxation techniques such as deep, slow breathing, experience a big drop (30% in some studies) in the intensity or occurrence of hot flashes and a significant decrease in tension, insomnia, anxiety, and depression.  If menopause triggers a deeper emotional crisis, psychotherapy may be required.  Regular meditation sustains many women. v

In conclusion, there are different approaches to menopausal symptoms.  If the goal is merely suppression of symptoms, then body-dominating, toxic pharmaceutical drugs may seem attractive.  But symptom suppression does not heal-whether by a synthetic drug or a so-called "natural" drug.  Drugs only deter and detour the body away from the healing process.  Conversely, the action of whole foods, whole herbs, exercise, relaxation, and other truly natural therapies support the body's innate healing ability.  Each woman must make her own informed choices.

This website has excellent nutritional protocols for menstrual and menopausal problems which are available in conjunction with the Symptom Survey.  Take the Symptom Survey to discover specifically what nutrition you need for your individual health problems.

i Tori Hudson, Integrative Med, Feb/Mar 2003, 2(1):14-26; Jonathan Wright, Nutrition & Healing, Sept 2004, 11(8):5 & Oct 2004, 11(9):8 & Feb 2007, 13(12):1-5 & Feb 2006, 13(1):3 & Feb 2005, 12(1):6-7; K Page, S Brownie & H Wohlmuth, Integrative Med, Feb/Mar 2005, 4(1):20-7; UC Berkeley Wellness Lttr, Dec 2004, 21(3):8 & Mar 2006, 22(6):8; Sidney M Wolfe, Worst Pills, Best Pills News, Aug 2006, 12(8):59-60; Health, May 2006, 20(4):22; LA Boothby, PL Boering & S Kipersztok, Menopause, 2004, 11(3):356-67; Susan Lark, The Lark Lttr, Jan 2006, 13(1):4-5; Jule Klotter, Townsend Lttr, Nov 2006, Is.280:37, citing Emily Kane, Managing Menopause Naturally Before, During and Forever, North Bergen, NJ: Basic Health Publications, Inc.; Patrick Friel, Townsend Lttr D&P, Jan 2005, Is.258:105-7; Tori Hudson, Townsend Letter D&P, Apr 2006, Is.273:113-5; Tori Hudson, Altern & Complemen Ther, Oct 2004, 10(5): 286-7.

ii B Wren, S Champion, et al, Menopause, 2003, 10:13-18; P Bronson, Integrative Med, June/July 2005, 4(3):36-7; K Bone, Townsend Lttr D&P, Feb/Mar 2003, Is.235/236:41-2; AR Gaby, Townsend Lttr D&P, Aug/Sept 2005, Is.265/266:28-9; Helene B Leonetti, Jennifer Lances, et al, Altern Therapies, Nov/Dec 2005, 11(6):36-8; E Lydeking-Olsen, et al, Eur J Nutr, Aug 2004, 43: 246-57; Tori Hudson, Townsend Lttr D&P, Apr 2003, 237:151; The John R Lee,

MD, Medical Letter, Oct 2000:7 &June 2003:7 & Oct 2003:7; Tieraona Low Dog, David Riley & Tony Carter, Altern Therapies, Jul/Aug 2001, 7(4):45-55; Lynne McTaggart, What Doctors Don't Tell You, Mar 2004, 14(12):10-12; Ellen Grant, What Doctors Don't Tell You,, May 2006, 17(2):6-9; Wen-Huey Wu, Li-Yun Liu, et al, J Am Coll Nutr, Aug 2005, 24(4):235-43.

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Originally published as an issue of Nutrition News and Views, reproduced with permission by the author, Judith A. DeCava, CNC, LNC.