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and Common Sense Solutions
by M. Sophia Compton, Herbalist and Health Educator
There are many theories today about how menopause should be treated, including questioning if it should be "treated" at all
Treatment seems to imply some kind of disease, yet many women do experience a profound sense of dis-ease in their bodies during the Change. In this article we will look at some of the symptoms that occur in many menopausal and peri-menopausal women, as well as a variety of strategies for dealing with these problems.
Hot flashes, or a hot flushing sensation, is the most telltale sign of a dawning menopause for most women. Often a 70 degree room will feel like 90 degrees. Even when the world around you seems quite cool, you may feel a "burning desire" to open all the windows or throw off the covers. Then, in the next moment, you may be shivering and regretting the fact that you did so. Hot flashes affect women in different ways, and often affects our mates as well. One woman reported that she was so warm that her husband discontinued use of their electric blanket because he didn't need it anymore. Her body heat kept him very comfortable!
For some women hot flushing may include the sensation of skin "crawling," dizziness, heart palpitations, or faintness. These uncomfortable sensations are not experienced by everyone; some women only experience the feeling of enveloping heat which soon goes away and which they find quite tolerable. For others, this symptom can be quite embarrassing or even debilitating. Flushing can last anywhere from several seconds to ten minutes or more.
Hot flashes are due to motor instability. The most common theory is that the body's thermostat in the hypothalamus is undergoing great hormonal fluctuations. Although the pituitary hormones we spoke about earlier, FSH and LH, are still produced at regular intervals, the ovaries no longer respond. Poor diet and stress are closely linked to the onset of hot flashes, although the ovary is the prime culprit in causing them. It has also been postulated that the unnatural estrogenic substances caused by the pollutants in our environment, called xeno-estrogens, may be precipitating "ovarian dysfunction, a circumstance not anticipated by Mother Nature." This is perhaps why women in industrialized countries experience hot flashes so much more than women in third world countries. We will examine this problem more during the interview section with Dr. John Lee.
It is averaged that 60%-80% of menopausal women are troubled by hot flashes for a period of five years or more. Some women experience them for 10 to 20 years, although their intensity and duration generally diminish with time. Only a small percentage of women have hot flashes for more than twelve years. This symptom, like other menopausal symptoms, can be predicted in part by examining how they affected our mothers. They are also usually more severe in women that do not sweat easily, who are very thin, or who experience surgical menopause.
Both progesterone and estrogen can temper hot flashes, although, traditionally, estrogen is prescribed. We will discuss the pros and cons of HRT in subsequent chapters. Estrogen and progesterone both affect body temperature during the menstrual cycle, but it is not known exactly how estrogen affects the hypothalamus during menopause.
Although the principle cause of hot flashes is vasomotor instability, it is important to understand what external causes may also precipitate them. If aware of the conditions under which you are most likely to experience hot flushing, you are in more of an advantaged position to control it. In many women, alcohol, coffee, soft drinks, or spicy foods trigger hot flashes. For others, it is external stress, or strenuous exercise. Warm weather exacerbates flushing for most women, or walking from a cool room into a hot one. Often, however, a hot flash comes out of the blue and there is little one can do but endure it: it usually passes in a short time. If hot flashes are too frequent or severe, you may want to look at hormonal methods for controlling them.
Although doctors are quick to prescribe HRT for hot flashes, there are a variety of natural remedies that many women have found which work quite well. Vitamin E, at high doses, (800-1000 mg a day) is extremely effective. (Do not take high doses of Vitamin E if you are diabetic.) Herbal compounds that contain plant hormones, such as dong quai, vitex, blue cohosh, black cohosh, unicorn root, wild yam, sarsaparilla, and ginseng work very well for some women.Ginseng should be used with some caution, especially the stronger, more "yang" varieties. Too much is very estrogenic and may cause some of the same problems as unopposed estrogen, although there are not studies documenting negative effects like hyperplasia. It is not recommended for those who have asthma, emphysema or have high blood pressure. It should not be taken with fruit.
Chickweed, elder flower, violet, and mint have also been used with success. Licorice root can act to balance hormone levels, but should be used with caution as it may lead to fluid and salt retention, in the same way that estrogen can. Some women report that moderate exercise helps alleviate hot flashes, probably because it raises endorphin levels, which generally drop during a hot flash.
Eat plenty of rice and soy products: tofu, miso, tempeh, soyflour. This diet is linked to reduced incidence of hot flashes among Japanese women. Recently, it was discovered that an ingredient in rice bran, called gamma oryzanol, is very effective in reducing hot flushing. The drug clonidine is also prescribed, especially in cases where women are ill advised to take HRT. However, there are numerous safe herbal and homeopathic preparations available in health-food stores that could be explored prior to using any kind of drug therapy, which may have unwanted side effects. Be sure and check out what progesterone cremes are available. They work remarkable well for most women.
The first controlled study using herbs to control hot flashes only began in the fall of l995 at Columbia-Presbyterian Medical Center in NY. In the future, we will know a lot more about how these useful herbs work, since phytoestrogens, or plant estrogens, are finally arousing interest in the scientific community. The fact that they have been used successfully in Eastern countries, such as China and Japan for centuries, however, should tell us something.
Sleep Disturbances and Night Sweats
For many women, hot flashes occur during the day; for others, they come primarily at night, causing a woman to awaken feeling hot and drenched with perspiration. These are called night sweats. She may feel the need to completely change her clothing or bedding, because they are too soaked to sleep in comfortably. This can have repercussions in terms of going back to sleep for some women, who may be light sleepers anyway.
The problem of night sweats is certainly a factor in causing sleep disturbances during menopause. But, even if it is not a symptom, lack of sustained sleep is itself a prevalent pattern in women between the ages of 45-55. Numerous studies indicate that hormone levels do affect sleep. The enormous interest in melatonin the past few years certainly suggests that our circadian rhythms are affected by certain hormones. Melatonin is secreted by the pineal gland, and like other hormones, decreases with age. Clinical studies have shown that melatonin is an effective remedy for insomnia, jet lag and shift-work maladaptation. Numerous women I know have reported that it helped them to get to sleep or stay asleep.
However, melatonin may have ill effects on some people, especially in large doses. In particular, people taking steroid drugs, or those who have allergies or auto-immune diseases should not take melatonin. Neither should women who want to conceive (not a problem for menopausal women, to be sure!) Melatonin can cause depression in some women. The body produces its own melatonin, and adding too much can occupy the same receptor sites of the body's own production and decrease it. So before you jump on the melatonin bandwagon for menopausal sleeplessness, consult your (hopefully holistic) doctor. Women often find that less, not more, is better. One naturapathic doctor advised a friend of mine that the 3 mg tablets are more than 100 times the amount the body needs and naturally produces. If I take melatonin for occasional sleeplessness, I halve or quarter the tablets and they work just as well. The natural production of melatonin also seems to require exposure to both sufficient daylight and darkness, which means it is detrimental to sleep under lights or in homes where streetlamps or floodlights can permeate the bedroom.
Bioflavonoids, Vitamin B5 (pantothenic acid) PABA and Vitamin E all work remarkably well in alleviating sleeplessness due to night sweats. Hops, chamomile, valerian and St. John's wort are all relaxing herbs that induce sleep. Passion flower, which elevates serotonin levels, is also good for menopause-related insomnia. Serotonin is a mood elevating neurotransmitter, a kind of natural antidote to depression which the brain produces. Tryptophan, a precursor of serotonin, increases with herbal supplementation of plant estrogenic substances.
Sage reduces excessive sweating, probably because it contains plant estrogens. Soy products are especially good. Blood levels of phytoestrogens are 10-40 times higher in Japanese women than in Western women, who are about 1/6 as likely to suffer from hot flashes and night sweats.
Paradoxical as it may seem for menopausal women, a hot bath taken just before bedtime is not only extremely relaxing, but it also raises body temperature, leading to a deeper, more sustained sleep. Calcium, taken at night, is also good for sleep problems; tryptophan levels increase if you have a warm glass of milk before bedtime. Vitamin B6 is an essential vitamin for converting tryphophan into serotonin. Finally, there are numerous relaxation techniques, many available on tape, such as progressive relaxation, which work remarkably well if practiced over time.
Ageism and sexism is the double-edged sword that confronts women who want to age with consciousness and an internal sense of freedom. We have been conditioned to believe that, as we age, men become more "distinguished looking", while women look more "grandmotherly." We are getting "over the hill." Somehow maturity in our culture perceives an aging man as more sexually appealing, but sees an elderly women as something of an unattractive old hag. In one study, where nearly as many men had gained weight as women, only one quarter of the men felt it had negatively affected their self-esteem, whereas 50% of the women reported that it had negatively affected their sexuality.
All of us women will develop a new body image as we enter menopause and the changes we observe will affect us differently. I, for one, think it is absurd to endure an extreme exercise program for the sake of male approval. My philosophy is that if a man so desperately wants the kind of body a woman had when she was in her 20's and 30's, he is having his own mid-life crisis and should deal with that, instead of having unrealistic expectations about what a 50 year old woman should look like, (whether she is in the bedroom or at the theatre.)
The fact of the matter is, most women don't "get fat" as they age because they have lost interest in their bodies or their men (or women.) There is a redistribution of weight and the weight "gain" is often around the waist and thighs, resulting in the "disappearing waistline" syndrome. In addition, about 50% of post-menopausal women will gain about 10 pounds. Unexplained weight gain may be a function of hypothyroidism, rather than aging. But normally, some weight gain and the shift in body fat is due to metabolic changes. Repeatedly, one hears stories in menopause groups about women who try to take off those few extra pounds, but the weight comes right back. To undergo extreme dieting in an attempt to recover the lost waistline may not only be a useless exercise; it may not even be healthy. Frequent or drastic dieting can be fraught with emotional turmoil, especially during menopause. In the famous Framingham study it was discovered that those whose weight fluctuated the most doubled their risk for developing heart disease.
Too much weight gain is almost always a sign of "estrogen dominance" or too much estrogen,and is one of the most common complaints of HRT.The cycle can be a bitter one because estrogen increases fat and fluid retention and the fat, in turn, increase estrogen levels. If a diet is very high in fat, or estrogen levels are too dominant, the breast tissue tends to accumulate it, thus increasing the risk of breast cancer. Modern research indicates that fat and estrogen are synergistic for increased risk of breast cancer Estrogen is stored in fatty tissue,so excessive weight gain should be seriously examined for all angles before undertaking extreme dietary regimes. It could be that all you need to do is to stop taking HRT.
Susan Weed, in her Menopausal Years: The Wise Woman Way encourages an optimistic attitude about the "normal" weight gain of about 10 pounds or more. Thin women have more hot flashes and often a more difficult menopausal passage. Give yourself permission to take up more space, she advises:
"Struggling with your weight or dieting is bad medicine for you now, resulting only in thin bones that break easily, extreme hormone shifts that will keep you from sleeping and thinking, and an inner fire reduced to ashes or burning out of control."
She advises high-calorie, hormone-rich foods such as spirulina, whey, wheat grass, mineral-packed foods, alfalfa seeds, and olives to create pounds that are supported by bone and muscle.
An androgen supplement instead of estrogen will cause the pounds to build in the muscle instead of in the fatty tissue, since male hormones encourage muscle tissue. We will discuss more about testosterone supplementation, a hormone which women's bodies also naturally produce.
Although a positive attitude about adding fat is vital to a woman's sense of well-being, it is important not to use menopause as an excuse for obesity. Too much fat increases our risk of both cancer and heart disease. And fat calories in food are generally stored instead of being used for energy, like carbohydrates. So worry less about the potatoes than the butter and enjoy yourself.
Many women perceive the term "vaginal atrophy" as an example of the oppressive nature of medical menopausal language, which for more than 100 years has painted a picture of the menopausal woman as deficient or diseased. "Atrophic vaginitis" does not mean the vagina has become a useless part of a woman's anatomy. However, thinning and drying of the vaginal walls can become problematic unless treated appropriately.
"Treatment", of course, implies that a symptom is present. If a woman is not sexually active, there may be no vaginal "problems" to treat, except for itching, which may or may not be that irritating to her. To "treat" all women in menopause as if they need to have their vaginas "healed" is to presume that a sexually active woman is the only healthy one. As Germaine Greer has noted:
"...menopause doctors see as one of their chief functions the curing of ailing marriages. Despite all the evidence to show that celibates are no madder and often a good deal healthier than the rest of the population, they persist in the irrational belief that regular psycho-sexual release is essential to the proper functioning of all individuals."
It is important to acknowledge that a celibate choice is a perfectly viable and healthy one for women. For some sexually active women, however, the changes in vagina and vulva can be particularly stressful. When estrogen and androgen secretion from the ovaries is decreased, often the cells of the vaginal lining are no longer resistant to friction and become quite thin. Therefore, intercourse, or insertion of anything into the vagina, becomes uncomfortable or even painful.
This pain with penetration is called "dyspareunia." Water- soluble lubricating jellies will provide some relief from vaginal dryness but they do not thicken the vaginal tissues and prevent them from cracking. This is probably the most common reason women take estrogen, which will return the vaginal and vulval tissues to normal.
If penetration has been discontinued for a number of years which stretch into a woman's menopause, the vaginal tissues have a greater tendency to shrink and may progress to rather severe scarring or shrinking. Generally, an estrogen creme is helpful to restore the vagina to sufficient resiliency if sexual relations are resumed, but it may take a considerable amount of time. However, using cremes, like taking estrogen in pill form, can be dangerous if a progesterone is not included. This is why doctors most frequently will advise Premarin or some other kind of oral HRT; but, as we will see, this has its dangers as well.
If a woman opts for estrogen creme, it should be used very sparingly. Of the three types of estrogen, estroil has been found to be non-carcinogenic and may be as useful in treating atrophic vaginitis and urinary tract infections as estroidal or estrone, which are the forms generally available in the United States.However, although estroil is readily available in European countries, it is difficult to obtain in the U.S., although it can be ordered from places like Women's International Pharmacy.
It is common for sexual arousal and orgasm to come more slowly as a woman ages and this is frequently the case with men as well. In the Masters and Johnson study done in the 1960's, at least 50% of couples eventually have some kind of sexual problem, which can be addressed fairly easily if both partners are willing to discuss it and look at their options. Most women experience as much or more pleasure in sex if their partner is patient and willing to communicate. If vaginal atrophy is accompanied by loss of libido, sometimes a small dose of testosterone creme is prescribed, although the formula has to be made by a pharmacist. If a woman chooses not to use any kind of HRT for her vaginal dryness or shrinkage, she may opt for using lubricants during intercourse that are natural, such as apricot oil. Some women find that insertion of a Vitamin E capsule into the vagina is helpful. Any kind of petroleum jelly should be avoided; it is not healthy for the vaginal walls. Some women use vaginal suppositories such as Lubrin Inserts or Replens.
Replens is a lubricant that, unlike most others available at the drug-stores, does lower vaginal pH. This is the effect that estrogen has on the vagina, which is why it is effective in providing long-lasting relief of vaginal symptoms. In a study conducted by Dr. Morris Notelovitz, the effects of Replens was compared with a water-based lubricant on women with vaginal complaints such as itching, burning, pressure and painful intercourse. While both improved vaginal moisture, only Replens lowered vaginal pH and actually increased vaginal secretions, decreasing the risk of tears to the vaginal lining. An added plus for using Replens is that it does not need to be applied prior to lovemaking, since a single application lasts up to 72 hours. The downside is that it is quite expensive.
K-Y Jelly and baby oil are both dangerous because such lubrication blocks pores, is difficult for the body to absorb or get rid of, and can cause allergies. If pain is too severe, an anesthetic jelly, called Lidocaine is available but should be used sparingly. It needs to be applied at least 1/2 hour before intercourse, then removed so it does not affect your partner.
A natural estrogen/progesterone suppository made by Bezinecken can be ordered from most naturopathic doctors. Ostederm, another estrogen/progesterone creme that is used transdermally, not vaginally, is also available. Much information about natural hormones can be procured by calling Women's International Pharmacy.(1-800-279-5708) Progesterone creme is often remarkably effective when applied vaginally.
Frequent urination is often a troublesome symptom during menopause, sometimes resulting in more severe bladder or kidney problems. One woman I knew reported that she was horrified to discover a bloody bowl when urinating, since she had been without a period for more than two years. She discovered it was a urinary tract infection (UTI) and was then treated with antibiotics, which killed all the good bacteria as well, and she soon developed a raging yeast infection.
The condition preceding severe uninary tract infections, called cystitis, occurs because the urethra and bladder are located adjacent to the vagina and these tissues all become more thin during menopause. The thinned vaginal and urethral walls can easily be irritated and are more susceptible to infection. If caught before it becomes too serious, cystitis can be bothersome, but like many other menopausal symptoms, can be treated using a variety of options. The first sign that you may be developing cystitis are the frequent trips to the bathroom, or pressure on the bladder which makes you feel like you need to urinate when you don't really have to. The next symptom is painful urination. Before cystitis develops into a more serious UTI, you should begin treating it immediately, both because of the pain and because the virus can spread so rapidly.
1. Try and re-establish a balanced urine pH by drinking a lot of cranberry juice, preferably unsweetened.
2. Take Uva Ursi several times a day. You can get it at a herb store, and make a tea or infusion out of it.
3. Eat a lot of vitamin C. It is one of the most beneficial things you can do to fight any infection. Powdered form is best, one quarter teaspoon every hour during an acute phase.
4. Take echinacea extract every 2-3 hours.
5. Take a hot bath with a cup of vinegar to restore acid balance.
There are also numerous precautionary measures that should be taken to prevent cystitis from developing:
1. Avoid spreading feces to the bladder when toileting by always wiping from front to back.
2. Squeeze out any excess urine you can after you think you are done urinating.
3. Go to the bathroom immediately after sexual intercourse, even if you feel you don't need to.
4. Eat yogurt frequently.
5. Do not wear tampons if you are still peri-menopausal.
6. Do not use commercial soaps directly on the vulva.
7. Do not use a diaphragm. especially with a spermicide.
8. Do not wear tight clothing and synthetic underwear.
9. Avoid commercial douches.
This may sound like a lot of "do nots" but cystitis can be a very unnerving problem if it re-occurs, and in about 15-20% of menopausal women, it does become chronic. Antibiotics rarely help, especially in treating the condition over a long period of time, and may even aggravate the virus. If cystitis is caused by vaginal and urethral atrophy, rather than an immune system breakdown or diabetes (both of which should be ruled out as causes) then estrogen may be the only cure. I found cystitis and UTIs to be so debilitating that I could not manage to carry on my normal daily activities. Because I did not want to take synthetic HRT I searched for something that would provide a more natural cure. But I really was desperate enough to try almost anything.
Fortunately, after much research, I discovered the natural form of estrogen, called estroil, available from Women's International Pharmacy. Used vaginally, it cured the problem almost immediately, and continues to prevent its re-occurrence with only 3 or 4 very low dose applications a month, as long as I attend to the other precautionary measures outlined above. Estroil is explained in more detail in Chapter 9, along with the various kinds of estrogen. Studies in Europe have demonstrated that estroil is safe and extremely effective in treating cystitis.
Another closely related problem that may occur during menopause is urinary incontinence, which simply means that the urine leaks out, especially during a sneeze, cough or laugh. Loss of urine may also occur with sexual intercourse. One way to avoid the diminishment of pelvic muscle tone is by the famous Kegel exercises, used both for urinary incontinence and to enhance one's sex life.
The first exercise consists in contracting the pubococcygeal muscle, which is done by pretending you are squeezing to stop the flow of urine. Be sure the stomach muscles do not simultaneously contract. Hold the contraction for 5-10 seconds. Focus on both contracting and relaxing. The second exercise is to do 10 rapid contractions and releases several times a day. These exercise are best performed lying on the floor, with knees bent and pelvis slightly raised, but once mastered, can be done anywhere. Another important clue in preventing urinary incontinence is to try and become aware of voiding incorrectly. That is, focus on relaxing the pelvic muscles while voiding, instead of pushing, which stresses the pelvic nerves unnecessarily.
Increased levels of certain vitamins and minerals can help with UTI's and incontinence. Selenium, Vitamin A and Vitamin C help lubricate vaginal tissue membranes. Herbal supplements include flax seed oil, yarrow, marshmallow, cornsilk, uva ursi, and garlic.
This section will deal with the drying and wrinkling of the skin, rather than the sensation of skin crawling, which often accompanies hot flashes, and can be more appropriately addressed when treating that symptom.
Some women believe that estrogen is a magic elixir for making the skin look younger, but the package insert material that comes with most HRT available dispels this as a myth. If used on the face, of course, it acts like a moisturizing creme, but most synthetic HRT does not come as a facial creme. There are progesterone cremes that are excellent moisturizers, but there is not a alchemical elixir for reversing aging: at least not yet!
There is growing interest in certian"anti-aging" formulas, which are definitely gaining in popularity today, but part of a mature journey through midlife is finding acceptance and joy in the transformations that our bodies go through. Certainly there is no reason to be ashamed about our concern with smooth, youthful-looking skin, but there is nothing shameful about wrinkles either. They are a badge of wisdom.
Estrogen can cause increased pigmentation, or slight darkening of the skin in some women; others do feel that estrogen reduces dryness of the skin and restores plumpness, probably because it causes weight gain in general. It is debatable whether estrogen actually increases skin collagen, however.There is a definite link, on the other hand, between Vitamin C and collagen synthesis, since it is well known that this vitamin is vital to the formation of skin and fibrous tissue throughout the body.
If skin loses its thickness, or wrinkles appear too rapidly, it may an indication that collegen loss is also occurring in the bones. This could signal the development of osteoporosis, since the loss of collegen in the skin often goes hand in hand with the loss of collegen in the bones.
As the skin ages, it becomes thinner and more prone to developing broken capillaries, called spider veins. Since it is less capable of holding moisture, a woman needs to apply more moisture, both externally and internally (drink more water!) if she is interested in maintaining youthful skin. If dry or flaky skin is problematic, try adding a couple teaspoons of raw flaxseed oil to your daily diet. Use it on salad or vegetables. You can also buy supplements in health food stores. It gives a luster to both hair and skin. So do lipsomes, found in certain kinds of herbal skin care products. Lipsomes essentially target and transport moisture rich ingredients to cells below the outer surface of the skin, thus aiding in enriching and protecting skin tone.
There are numerous natural emollients, such as cocoa butter, apricot kernal oil, and almond and olive oils. Alpha hydroxy acids (AHA's) have been shown to work well in rejuvenating skin by exfoliating the skin naturally, although concentrations must be 8% or more (check the labels: many have practically no AHA's; the cheaper brands are just as good as the more expensive since they often contain 5-10%) . Concentrations of 14 % or more act as chemical peels and are generally not available over the counter. You can also use your own fruit acids: both papaya and strawberries make a wonderful facial paste.
There are important things you can do to protect your skin, of course, the most important being protection from the sun. Ultraviolet radiation (UR) is one of the most detrimental causes of premature skin aging as well as skin cancers. One should always look for full spectrum protection in a sun screen lotion to screen out harmful rays and if there is prolonged exposure, should be re-applied every two hours.
Copper is an essential nutrient for supple skin, as is zinc. Both internal and external use of Vitamin E is also recommended. Vitamin A, in the form of mixed carotenoids: Vitamin C, selenium, and certain kinds of enzymes are important antioxidants to protect skin as well as all body cells from free radicals: those scavengers that terrorize genetic material, leading to a more rapid aging. Free radicals are caused by the excess pollution in our environment, cigarette smoke, and chemicals in foods. Antioxidants have been repeatedly shown to prevent and reduce cell damage and rebuild collegen fibers, offering protection from the destructive effect of a world rampant with free radicals. Don't underestimate their influence: none of us escape them. They are in fluorescent lights, videos and TVs, viruses, rancid fats, alcohol, smoke, chemicals, and the air we breathe.
There are other, less common, skin problems that may occur with aging. If you are taking HRT and you have a break-out of a skin-rash, it is probably due to the progestin in the HRT. If you are experiencing an outbreak of acne, it is most likely due to excess androgen production and can be treated with retinaic acid, a form of Vitamin A. Very flaky or itching skin is a condition called seborrhea and can be cleared up with certain topical cremes, particularly progesterone. Estrogen, especially in a creme form, can cause skin discoloration, rashes, as well as oily skin.
As we age, the cycle of sloughing off old cells and replacing them with new ones slows down. Therefore, it is not necessary to go to bed every night with tons of facial creme: it only clogs the pores, especially if you are prone to night sweats.While going through menopause, you should use creme more sparingly at night to keep your pores open so they can rejuvenate. Use very little soap and cleansing cremes free of mineral oil. Above all, feed your skin from within and maintain a positive attitude: this goes the longest way to enhance a beautiful and healthy appearance.
Loss of Libido
Although sex hormones are not the exclusive property of one sex or another, testosterone is often thought of as the "male" hormone; estrogen as the "female." However, women also produce testosterone from both the ovaries and the adrenal gland. It is responsible for libido in both sexes. Studies indicate that women report both an increase and a decrease in sexual activity and intensity of orgasm after menopause. About 10% of women report an increase in libido, probably because of the sexual freedom and privacy from children which occurs during midlife, creating more spontaneity in the couple's sexual relationship. Dr. Susan Lark believes that at least 10-20% of women experience a drop in libido during the climacteric; in others, the testosterone levels may not drop for several years. Other studies indicate that libido problems are much higher, especially when coupled with problems of vaginal dryness. In Notelovitz's study, women with vaginal atrophy reported a 71% decrease in sexual desire. One Kinsey report found that women who were not enthusiastic about sex used menopause as excuse to curtail sexual activity. Often normal menopausal symptoms, especially hot flashes and fatigue, can suppress sexual desire. When the vagina has become irritated or atrophied, any form of penetration, especially excessive friction, can cause such discomfort that women naturally tend to begin avoiding sexual relations. In this case, addressing the problem of vaginal dryness may be all that is necessary.
In women who suffer from loss of libido, a small amount of testosterone can increase her sexual sensitivity and orgasmic gratification. Estrogen alone will not restore libido. The "masculine" hormones, called androgens, are produced by both men and women; however, they will cause masculine characteristics in a woman if not used sparingly, stimulating increased hair growth, acne or lowered voice. Nonetheless, giving extra testosterone to some menopausal women greatly improves their sense of well-being. Drs. Notelovitz and Tonnessen have noted that low androgen levels are associated with depression, headaches, low libido and bone loss. They quote studies which link higher levels of testosterone to greater feelings of desire and more frequent sexual fantasies in postmenopausal women. Such women purportedly had more energy, made love more often and had less headaches.
They suggest that androgen-estrogen combinations work better in relieving depression than estrogen alone; and there is often a direct relationship between depression and loss of libido. Frequently, the combination called Estratest is administered to women who complain of low libido, but given orally in this way, it may cause more serious side effects, since it is not clear how negatively testosterone affects the liver and the heart. In addition, many clinicians are reticent to add testosterone to the estrogen-progestin "cocktail" because the idea of giving a "male" hormone to a woman whose "femininity" is already threatened by her entry into menopause is too uncomfortable a thought for many male doctors to contemplate. Testosterone is, after all, the hormone most frequently linked to aggression, although some research now appears to debunk this as a biochemical myth.
Testosterone is, nonetheless, often prescribed for women's increased sexual functioning after a hysterectomy or if her ovaries are not functioning. Estratest is available in half-strength in pill form for women who develop facial hair growth or other unwanted androgen characteristics. Or a testosterone cream or gel may be made by the pharmacist at the doctor's request. It should be noted that, while natural progesterone has been known to restore libido in some women, the synthetic progestins frequently decrease it. Therefore most HRT combinations, unless made naturally, can have a canceling out effect, even if they do include testosterone. You may want to investigate this, especially if you are taking Provera.
While estrogen does not, in itself, increase libido, it is often used with a testosterone cream because it relieves painful intercourse and restores natural vaginal lubrication. I highly recommend using the natural forms of estrogen (estriol) and testosterone, both soybean derivatives, which are available from Women's International Pharmacy (at very reasonable prices.)
Both are available in creams or gels, which are the safest way to use these hormones.Used transdermally, estrogen and testosterone by-pass the liver; and both, if taken orally, can be toxic to the liver over time. Some cremes may be applied directly to the genital or vaginal area. However, any kind of gel should never be applied vaginally because it has a alcohol base and can harm the vaginal walls. If taken orally, testosterone should not exceed 75 mg per month. Sometimes, women prefer to take testosterone cypionate in a shot, which also bypasses liver and digestive tract, usually administered every 3-4 weeks. More information about how testosterone affects the heart and bones can be found in later sections.
There is a growing body of research that indicates that estrogen-androgen hormone replacement therapy may well be the wave of the future. The European Menopause Journal in l995 summed up the studies to date on the use of androgens for menopausal women. It noted that "the enhancement of the quality of life is the prime requisite in adding androgen to the HRT regimen" since it not only increases libido, energy, and a sense of well-being in women, but it also increases bone mineral density and may protect against breast cancer. In recent studies, more than 90% of women on estrogen-androgen therapy were satisfied with the results, compared to much lower statistics in studies with estrogen-progestin therapy.
Helen Singer Kaplan, a psychiatrist and author who has written on androgen deficiency during menopause states that:
"Testosterone deficiency in women produces a well-defined clinical syndrome that centers around decreased sexual desire and diminished orgasm. All of the patients I have seen...mourn for their lost sexuality. Those who recovered their sexual feelings were jubilant. The evidence is convincing that prudent testosterone replacement is effective...however,because many physicians continue to cling to the notion that testosterone is the "male" sex hormone which women "don't need" the syndrome is currently underdiagnosed and undertreated."
Sometimes couples experience midlife and hormonal changes simultaneously. For example, if the male partner is anxious over his arousal time or lack of orgasm, he may transfer his insecurity to the woman, who then may develop her own psychological problems about sexuality. While women encounter their own particular midlife crises, as discussed in the first half of this book, it has been noted that often men have a crisis of "performance," both in their sexual and work roles. Midlife is often a time of emotional or spiritual turmoil in both men and women. Studies indicate that "although there is technically no male menopause on which to blame the rather peculiar behavior some men exhibit as they pass the age of fifty, many female patients say they are confused by the odd behavior in their middle-aged spouses."
The best remedy in this case is communication, counseling and acceptance that sexual response is changing; therefore other avenues--such as renewed sensuality in love-making--should be stressed. Or the couple may both choose to use testosterone replacement. Often, testosterone is given for the "male menopause", just as estrogen is administered to a woman, but such hormonal imbalances should be first discovered by a blood test, since impotence and ejaculation problems in men can be caused by a host of other factors. In particular, premature or retarded ejaculation may result from the medications most often prescribed to men during this age period: antidepressants, tranquilizers and antihypertensive drugs. Male hormones may not be appropriate if a man has had or is disposed to prostate cancer.
Causes of low sexual desire in both men and women are hypothyroidism and exhausted adrenals. Antihistamines can decrease sexual desire or delay orgasm in both sexes. Vitamin nutrients like zinc, niacin, iodine, and copper have a positive relationship with sexual enjoyment, since they are associated with good hormonal and thyroid balance. The herb sarsaparilla has been positively associated with libido in both sexes.
Sexual changes are one of the challenging aspects of a couple's midlife. If they are committed, caring and communicative however, they can together discover ways to use this time to deeper, rather than estrange, their relationship. Both partners can also focus on maintaining a healthy body and using nutritional support to further sustain their sexual longevity.
When I was peri-menopausal, I began to experience PMS symptoms, which was a foreign experience to me, since normally I had had relatively mild periods with no serious pre-menstrual emotional changes. So I was shocked to discover that the longer I went between periods--which got fewer of course as time went on--the more irritable, depressed, fatigued, and prone to tears I also became. I found myself waiting anxiously for my bleeding to start because much of my symptomology would disappear as soon as it did. Thankfully, I discovered the work of Dr. John Lee and natural progesterone, the subject of much of this book. It leveled my moods remarkably and allowed me to feel like I was sane again.
It is not simply with humor that I refer to my sanity and menopause in the same breath: the mood swings really do make a woman feel like she is slightly crazy. One reason is that there is no apparent cause for the roller-coaster ride: at least not one discernible in the outside world. A woman may therefore feel very confused because there does not appear to be any "real" reason for her feelings of anxiety, or her black days when she can't seem to get anything done. And this is simply because the roller-coaster ride is happening inside: it is hormonal. One study found that nearly 50% of women who suffered psychological crisis, or committed crimes, or were hospitalized for accidents, were suffering from PMS at the time. And PMS symptomology is a very real part of menopause for some women.
Dr. Katherina Dalton has become world famous for finding success for PMS using high-dose progesterone. She originally discovered that her migraines disappeared during her pregnancy (when women produce very large amounts of progesterone: 30 to 50 times higher than normal) and gave herself progesterone injections after the birth of her child. Her headaches did not return. Her early studies on PMS and progesterone were the inspiration to other pioneers, such as Dr. John Lee, Dr. Alan Gaby, and Dr. Christiane Northrup, who continue to use it to treat menopausal women today.
Giving ourselves room to explore our internal changes at mid-life is a very important part of going through the Change creatively. But we also need to know what works for us in terms of treatment so that we can function and lead productive lives.
Herbal remedies for irritated nerves include garden sage, black cohosh, passion flower, and dong quai. Stronger, more relaxing sedatives include valerian, motherwort and skullcap. St. John's Wort and oatstraw work well for depression for some women. Dong quai and St. John's Wort, especially in tincture form, are not only good for dark moods, but are helpful for sleeping problems. Be careful with dong-quai, however, as it may cause heavier bleeding. If this happens both yarrow and vitx are helpful to curb bleeding. Some women find that the homeopathic remedy, Sabina, is helpful for heavy bleeding during the peri-menopausal stage.
Serotonin is the famous neurotransmitter that appears to promote a sense of well-being, and is quickly produced in the body by eating carbohydrates, such as bread, potatoes and pasta. Studies indicate that women who binged on starchy foods experienced significent relief from anger, tension, and moodiness during their pre-menstrual periods and these effects were attributable to an increase in serotonin. Stress and trauma lower serotonin production. So can excess estrogen, alcohol, and light deprivation.
Nutrients that aid in the chemical conversion of serotonin are tryptophan, an amino acid found in seeds and nuts, and Vitamin B6. A Vitamin B complex--the "stress vitamin"--is vital to a woman's diet at this time in her life. Low levels of zinc and calcium are linked to depression, and menopause is a time when both of these supplements should be added to the diet for numerous other reasons as well. Other important supplements to improve mental symptoms are folic acid, potassium, niacin, and Vitamin B12. Of particular importance are magnesium and B6. Michael Murray, N.D., in his book The Healing Power of Foods, writes:
"A diet rich in plant foods increases the body's levels of magnesium and vitamin B6, critical nutrients for PMS that have been shown to produce positive effects when supplemented to the diets of women with PMS. Foods with high magnesium and vitamin B6 levels should be increased in the diet. Items especially rich in these nutrients are whole grains and legumes."
Endorphins are another brain chemical that counteracts feelings of anxiety and depression.Since the late 1970's, research has indicated that exercise is a natural and effective way to raise endorphin levels. Many have found running relieves depression. Certain foods, such as chocolate, have been much discussed because they are also endorphin-producing, but high sugar foods should be avoided by those with sensitive blood sugar levels. Erratic drops in blood sugar for some women can cause the very symptoms they are seeking to avoid: depression and anxiety. Maintaining even blood-sugar levels is closely linked to even moods.
There are some amino acids prescribed by some holistic practitioners for depression, which can be very effective, particularly catemine and l-tryosine. Homeopathic remedies work well for some women, and may be prescribed by your health-care practitioner. Gingko biloba has been gaining popularity for its ability to improve memory and mental health in general, and is gaining interest in the scientific community. It is one of the most frequently prescribed medicines in Europe. It appears to improve transmission of nerve signals and be effective for treating confusion, tiredness, and anxiety.
Sometimes women's doctors advise them to take HRT for treating mood swings.However, both estrogen and synthetic progesterone are themselves culprits in causing depression and anxiety, and for this choice to be a viable one, it should be thoroughly researched. Natural progesterone, as explained in later chapters, works extremely well for most women in alleviating menopausal moodiness.
Dr. John Lee has pointed out that excess estrogen is the primary cause of depression, loss of libido, inability to handle stress, irritability, headaches, as well as a host of other physical symptoms related to PMS. The reason women in industrialized countries suffer from estrogen dominance, even in menopause, is because of the abnormal leeching of xeno-estrogenic substances into our environment. He concludes that even premenopausal women in industrialized countries suffer higher than average levels of estrogen and therefore variable inappropriate surges of estrogen, leading not only to estrogen dominance but to a severe progesterone deficiency.
So, before you too readily take a prescription for ERT (estrogen replacement therapy) please become aware of all your other options. Many alternatives are great wonder-workers!
The major symptomology dealt with in this section comprise the most common challenges posed to menopausal women in their journey through the Change. There are numerous others, however, which are less prevalent. I am including them for the sake of a more comprehensive list of symptoms. Often a woman is relieved simply to discover that her particular problem is not "all in her head," or worse yet, portends a more serious illness, but is instead caused by her menopause.
Some women report, for example, hair loss or thinning, or an increase in facial hair; light-headedness or loss of balance; changes on body odor; an electric shock sensation under the skin; more gastrointestinal distress or flatulence; changes in heartbeat; tingling in extremities; more gum problems, such as bleeding; more susceptibility to allergies; aching joints and muscles; feelings of apprehension, anxiety or panic; excessive bleeding; memory lapses; an increase in headaches; or extreme fatigue. Work closely with your health practitioner and keep exploring alternative options: this, together with a positive attitude, will gear you in a direction toward finding answers to dealing with these problems.
Adapted with permission from the book Women At The Change by Madonna Sophia Compton from Llewellyn Publications.
Sophia Compton is an herbalist, educator and founder of Sophia's Herbals. She is the author of three excellent books, including Herbal Gold: A Millennium Medicine Chest. Learn more at Sophia's Garden
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