Menopause is a normal and natural transition in a woman’s life when her ovaries decide to stop producing estrogen and go into retirement. In general, menopause begins around age 50 and in the United States women will live approximately 30 years beyond this phase. This is an important time for women to focus on their health, as estrogen deficiency is linked to many symptoms and diseases. Using a combination of Ayurveda and Naturopathic medicine to support a women’s body through this phase is a powerful way to promote hormonal balance and ease menopausal concerns.
The Physiology of Menopause
The age of menopause is unaffected by race, socioeconomic status, age of your first menses, or number of prior ovulations, and appears to be genetically determined. Women who experience earlier age of menopause have had a history of smoking, hysterectomy, toxic exposure, chromosomal abnormality, autoimmune disorder, chemotherapy or radiation. At the level of the ovary, there is a depletion of ovarian follicles that becomes more resistant to stimulation from the follicle stimulating hormone (FSH). Ovulation becomes irregular, and finally ceases altogether. Once the ovary no longer responds like it has previously, progesterone also ceases.
Fortunately, not all sex hormones are completely gone at this point, 50% of testosterone comes from ovaries and adrenal glands and the other 50% comes from the liver, the skin, and the brain. The adrenal glands also produce, androstenedione, which converts to estrogen in the body fat and other tissues in the body. For some women, this may be enough estrogen to help with an easier transition. Since the adrenal glands are a primary source of sex hormones after menopause, those who have poor adrenal function caused by chronic stress, lack of exercise, poor sleep and excess caffeine may experience more severe symptoms.
Principle Health Concerns
Changes with menopause can be mild, moderate or severe. The most common symptoms women experience are hot flashes, night sweats, sleep disturbances and vaginal dryness, these are also the primary reasons most women visit the doctor. Other symptoms include weight gain, fatigue, headaches, muscle or joint pain, urinary incontinence, UTI’s, depression and/or anxiety, memory changes and changes in sexual function. Other major health concerns include osteoporosis, cardiovascular disease, breast cancer and Alzheimer disease. These conditions can dramatically change one’s life and are an important reason to seek the help from a Naturopathic Physician to help in the prevention or slowing down of progression.
Testing for Menopause
There is no test for menopause, which may seem surprising with all of the medical advances that have taken place. The main basis for diagnosis is based on a patient’s medical history and clinical presentation. Testing to differentiate and rule out other possible hormonal imbalances may occur, but for menopause there is no actual test. Although, testing FSH can help infer that menopause has been established if it is above 30 mIU/mL. This test is not that accurate because FSH can fluctuate and is difficult to measure in women using hormonal contraceptives or hormonal replacement therapy (HRT).
The HRT and BHRT (Bio-identical hormone replacement therapy) Debate
The Women’s Health Initiative (WHI) is a long-term national health study that focused on strategies to prevent heart disease, breast and colorectal cancer and fracture in postmenopausal women. The WHI was a 15-year project that resulted in some of the most definitive and far-reaching research for women’s health ever done in the U.S. Women who participated in one of the trials were put on an HRT medication called Prempro (estrogen) or were given a placebo. The trial ended early because researchers found that subjects had a greater incidence of coronary heart disease, breast cancer, stroke, pulmonary embolism compared those receiving a placebo. Due to the results of this trial, HRT is no longer the recommended therapy for menopausal symptoms.
There is still concern over the use of bioidentical hormones, which include progesterone, estradiol and estriol. Special concern is with the safety of BHRT compared to traditional synthetic and animal-derived versions. In 2009, a study out of Postgrad Med, concluded that physiological data and clinical outcomes demonstrate that BHRT are associated with decreased risk of breast cancer and cardiovascular disease. They are more efficacious than their synthetic and animal derived counterpart and remain the preferred method in HRT. But, there are other approaches other than HRT and BHRT that have been proven to be helpful in menopause.
How Ayurveda and Naturopathic Medicine Can Help
Using a strategic approach by combining Ayurveda, traditional medicine from India, and Naturopathic medicine is a great way to combat menopause without experiencing an increased risk for life-threatening diseases. The main goal of this combined approach is to alleviate symptoms and prevent/treat osteoporosis, cardiovascular disease and other aging-related diseases. After symptoms and risk have been assessed, recommended treatment options may include herbal supplementation, nutrition, exercise, yoga, breathing exercises and orthomolecular therapy.
The Ayurvedic perspective on menopause is that it is a normal sign of aging and is known as the golden age. Women are viewed as becoming more elegant and are celebrated, quite different than the American perspective. The secret to a comfortable and easy transition is living a healthy lifestyle. The more balanced you are before you reach menopause largely determines how you will react to menopause. To become “in balance”, eating a healthy diet and getting exercise will help to provide a foundation of health. Symptoms vary from women to women, and Ayurveda describes the type of symptoms you have as being dependent on your body type or dosha. The three types of doshas include Vata, Pitta and Kapha. If you have an imbalance in one of these doshas you may experience the following menopausal symptoms:
Vata:
- Nervousness
- Anxiety
- Panic
- Mood swings
- Vaginal dryness
- Loss of skin tone
- Feeling cold
- Irregular periods
- Insomnia
- Mild or variable hot flashes
- Constipation
- Palpitations
- Bloating
- Joint aches and pains
Pitta:
- Anger
- Irritability
- Feeling hot
- Hot flashes
- Night Sweats
- Heavy periods
- Excessive bleeding
- Urinary tract infections
- Skin rashes
- Acne
Kapha:
- Weight gain
- Sluggishness
- Lethargy
- Fluid retention
- Yeast infections
- Depression
- Lack of motivation
- Slow digestion
Good News: Hot flashes and Menopausal Symptoms May Reduce Breast Cancer Risk by 50%!
A recent study done at the Fred Hutchinson Cancer Research Center (FHCRC) found that women who have experienced hot flashes and other related menopausal symptoms can have up to a 50% lower risk of developing common forms of breast cancer over menopausal women who never had such symptoms. Also, the protective effect increased with more frequent and severe hot flashes. So those of you waking up in the middle of the night drenched in sweat, this is something positive to take away from the experience.
The link between decreased cancer risk and menopausal symptoms has to do with hormones, estrogen and progesterone. Menopausal symptoms occur due to a fluctuation and then drop in these hormones, which can play an important role in the development of most breast cancers. Symptoms are a direct result of gradual cessation of these hormones. So, women who experience hot flashes and night sweats may have lower risk due to decreased estrogen levels.
In the FHCRC study, 1,437 postmenopausal women in the Seattle area were interviewed-988 had been previously diagnosed with breast cancer and 449 of whom had not, to serve as a comparison group. The women discussed symptoms related to perimenopause and menopause, such as hot flashes, night sweats, insomnia, vaginal dryness, irregular or heavy menses, depression and anxiety. If more studies can happen to confirm these findings we could enhance our current knowledge and understanding about breast cancer etiology and prevention strategies.
Although menopausal symptoms are not particularly pleasant, this study helps to remove some of the negative feelings regarding these symptoms and the impact it can have on your daily life.
Cool Down During a Hotflash
Shitali is a wonderful breathing exercise to soothe, relax and cool the body and its nervous system.
How to perform Cooling Breath (Shitali):
- Open your mouth to form an “O” shape
- With your mouth in this position, form a funnel with your tongue and place it between your lips. If you can’t roll your tongue, just purse the lips making a small “o” shape with your mouth
- Slowly inhale through the tube of the tongue, swallow the breath
- Relax your tongue and mouth, and then exhale through your mouth
Yoga for Menopause
A study in Menopause, reported that after 8 weeks perimenopausal women experienced a decrease in climacteric symptoms, perceived stress and neuroticism when incorporating an integrated approach to yoga therapy, as opposed to simple exercise performed for 1 hr/d x 5 days. The yoga therapy was comprised of surya namaskara (sun salutation) with 12 postures, pranayama (breathing practices), and avartan dhyan (cyclic meditation).
Case Study
I recently had a 56-year old female presenting with menopausal symptoms that included mild hot flashes (they didn’t bother her), extreme anxiety (interrupting sleep), weight gain, low libido and vaginal dryness. Her main goal was to have relief from her symptoms (mostly anxiety) and work on creating a wellness program that would put her back on track so she could be the healthiest she could be before turning 60. Her lab work revealed elevated cortisol and cholesterol. Together, we created a plan that worked for her lifestyle, but still helped her achieve her goals. Lifestyle changes included coffee cessation, cooling breath, daily yoga and sun salutations. For her low libido and vaginal dryness I prescribed a product containing an herb, maca. To help with anxiety I recommended an adaptogenic herb, holy basil. At her 2-week follow up she reported feeling like a “brand new, hormonal teenager” in reference to her libido and vaginal dryness. Her anxiety dramatically reduced by 80% and she was able to sleep throughout the night. 3 months later she is only taking the maca product and holy basil as needed. After more intense work on her diet and exercise regimen, she has lost 10 pounds, lowered her cholesterol within a normal range and reports that she still feel like a younger version of her old self.
Dr. Lindsay Jones-Born is a licensed naturopathic physician in California and is an active member of the American Association of Naturopathic Physicians. Born Naturopathic Associates, Inc. is the prime location in Alameda, CA for integrative medical care for patients off all ages and genders, for acute and chronic conditions. For more information or to schedule an appointment, please visit www.bornnaturopathic.com or call 510-550-4023
