Biological Facts and Social Fallacies

Menopause, by definition, describes only the cessation of menstrual bleeding.  The broader definition includes the change of life, usually between the ages of 48 and 52 that is associated with hot flashes, night sweats and vaginal dryness in 4 out of 5 women.  In our culture, where female youth is highly venerated, menopause is seen as a disease process, which requires synthetic chemical drug treatment.  Other cultures take a very different view. Middle-aged women enjoy increased status in the family and greater freedom in society.  Menopause and end of child-bearing become positive events in a woman's life.

In our own society, since the 60's, women's rights and perceptions of themselves have expanded.  Women are questioning "medical authorities".  They want to know the risks of taking synthetic or inappropriate estrogens the rest of their life.  The women of today are more interested in understanding how their body works and what lifestyle changes and natural treatments can do for them. 

This work has four purposes:  one is to give you some background about the change of life.  The second is to show you how you can determine through new state-of-the-art laboratory testing whether you’re going through the change and actually require intervention.  The third is to show you a natural way to restore your hormonal equilibrium and enjoy this wonderful time in your life without physical discomfort, mood swings, or unwanted side-effects such as higher risk for cancer.  The third is to give you the understanding on what methods are available for you to effectively monitor the future of your health in careful, non-invasive ways.

 Menopause and Menstruation

 Women going through menopause relate a variety of menstrual irregularities from spotting to heavy flows coming closer together. Let's review our high school biology about the menstrual cycle. Each month the ovaries produce estrogen in increasing amounts to build up the lining of the uterus.  On the 14th day the ovary produces a mature egg which travels down the fallopian tube to the uterus.  After ovulation the ovary continues to produce estrogen but produces progesterone as well.  Progesterone causes the uterus to secrete special fluids that prepare it for pregnancy and stabilizes the growth of the cells that line it.  When pregnancy does not occur, the ovaries stop all hormone production, estrogen and progesterone blood levels drop off rapidly and the uterine lining loses its hormonal support and sloughs off leading to the “period” of vaginal bleeding. 

When a women enters her 40's hormonal outputs vary and periods can come closer together.  The amount of bleeding may be lighter than before, but sometimes it can be very heavy.  Sometimes, when ovulation does not occur, a period is skipped.  This failure to ovulate can cause  prolonged "spotting" and erratic bleeding, since the ovaries do not secrete much progesterone until ovulation occurs.  In the absence of progesterone, estrogen levels tend to rise and fall and the lining is shed very irregularly.

As a women reaches her 50th year menstrual periods will generally get further apart, then lighter, and then stop completely. After a women has gone 1-2 years without bleeding at this age, she has completed menopause, can no longer get pregnant .

 The Adrenal Connection

Why does this menopausal change occur?  The pituitary is programmed by your genes to allow your ovaries to completely stop secreting all hormones so you can’t get pregnant anymore and can have a less rigorous autumn of your life. During this change the adrenal glands that sit on top of kidneys are given the job ultimately of making your estrogen, testosterone and progesterone.  The adrenal glands do this in two ways: first they reroute a hormone called DHEA to the fat tissue where it is processed into estrogens and testosterone.  Second they convert cortisone into progesterone. 

 Irregular Menstrual Bleeding

Heavy bleeding can occur around menopause because of fluctuations in estrogen/progesterone levels and for other reasons. Sometimes high estrogen levels occur and are not balanced by progesterone leading to heavy flows.  Usually the patient will consult a gynecologist who will check for uterine fibroids, polyps or cancer all of which can cause irregular bleeding.  If there is no sign of masses in the uterus a one or two week of natural progesterone which will stabilize the uterine lining and the bleeding will stop.  The heavy bleeding might reoccur with the next period and another course of progesterone may be necessary.

Let's talk about some other natural ways to control heavy menstrual bleeding:

Alcohol consumption:  With age comes a decline in the liver's ability to metabolize alcohol.  Alcohol affects the ovaries, causing a decrease in the production of estrogen or progesterone. During menopause it's prudent to drink only small amounts at social occasions only and quit entirely if you have bleeding problems.

Caffeine consumption:  Caffeine is an adrenal stimulant and repeated use can weaken the adrenal glands ability to produce the precursors to estrogens and progesterone needed to control menstrual bleeding and prevent menopausal symptoms.  Caffeine is really just a legal upper which over years insidiously wears away at our adrenal integrity. If you are experiencing irregular bleeding you need to become independent of this and all stimulants for an easier transition into menopause. 

Smoking:  Smoking cigarettes also affects the adrenal glands. Smoking can cause ovulation to stop too early and bring on early menopause which is often troublesome.  Women who smoke have a greater risk of developing uterine fibroids and polyps.  Acupuncture has shown remarkable results in helping people stop smoking with no side-effects.  There are Chinese or certified acupuncturists in most major cities in the U.S.

Emotional Stress:  Scientists are learning that how we feel can have a tremendous impact on our physiologic processes.  Emotional upsets can cause little or no bleeding in some women and excessive or prolonged bleeding in others.  One theory is that as time marched on for homo sapiens it became better for the human species that fewer pregnancies occur in times of great social or personal disruption or during prolonged episodes of physical exertion, fatigue, or fear.  Consequently, the genes evolved to code the glands to act differently under stress.  When a women experiences negative emotions for extended periods, the pituitary gland in the brain that controls ovarian function may not operate well, ovulation may become irregular, and various hormonal imbalances can result.  When a stressful situation is resolved a women's irregular bleeding will often go away. 

Some women find help during times of heavy emotional stress by joining local women's support groups that are often available through local churches.  If there is nothing available in your area you can always start one by putting a notice up on bulletin boards at churches, schools, stores and laundromats.  For others, counseling or group counseling is helpful.  But do something.  Studies show that the chief difficulty with overcoming stressful situations is taking the first step, believing that help is available, that you deserve it and seeking it. 

How Does a Hot Flash Work?

Temperature regulation is achieved by several mechanisms. When we become chilled we turn pale which means our body is diverting blood to deeper organs and tissues to preserve body heat. We also shiver which creates heat by causing muscular contraction. When we experience excess heat conditions our body flushes to bring the heat to the surface and then releases the heat by transferring it to sweat which evaporates off the skin.  The area in the brain that sets the internal thermostat of the body at 98.6 is near the pituitary which controls the estrogen and progesterone levels.  For reasons that are not quite clear, as a women enters menopause, the fluctuation of hormones and feedback mechanisms of the pituitary periodically sets the thermostat plunging lower, thus causing the body to quickly adjust, which causes a rapid flush and sweating.

It is interesting to note that in brain research, it has been found that the neurotransmitter that triggers hot flashes, norepinephrine, is increased by drinking coffee.  Stress reduction practices such as yoga and tai chi may reduce levels of norepinephrine in the body. 

 What About Taking Estrogen?

Many women these days are put on chemical or inappropriate estrogens after menopause or a hysterectomy.  There is a definite need for a safe estrogen supplement for women to prevent hot flashes, fatigue, osteoporosis, hip fractures, vaginal dryness, mood swings and other symptoms.

What are the risks?  The kind of estrogen conventional doctors prescribe their patients is fundamental to risk.  See the chart below:

When in all actuality the truth is estrogen only slows down bone loss.  Women on estrogen can still break their hip.  What doctors often do not make clear is that each year your risk of breast, uterine, vaginal, liver and other forms of cancer go up while taking chemical estrogen.  That means that each year you stay on chemical estrogen your risk of cancer gets higher and higher.

If you have a history of breast or uterine cancer or you were ever given diethylstilbesterol (DES), prior to menopause or a hysterectomy, your risk of stimulation by the chemical estrogen of female cancer is so high that doctors are supposed to refuse to prescribe estrogen therapy for the relief of your symptoms.

But during the menopause, or after a hysterectomy, because of such stress factors as family, career, and relationship difficulties, estrogen levels may require natural support until the stress lightens and the estrogen levels normalize.  There are three kinds of estrogen E1, E2 and E3.

E1 = Estrone  (Ogen)

E2 = Estradiol  (Premarin)

E2 = Estriol  (natural plant source)

E1 and E2 are the strong estrogens prescribed by most medical doctors and are cancer causing when used continuously.  E3 also known as Estriol, is a natural plant estrogen extracted from plant materials such as wild yams (Dioscorea villosa). Wild yam is harvested in the jungles of southern Mexico and is also called the Barbasco plant.  Because it is a plant it cannot be patented, so large drug companies continue to push  their patented estrogens so that they can reap big profits  Estriol has been shown to actually protect women from breast and uterine cancer.  It is used therapeutically in Europe and other countries as a treatment for menopause and after a hysterectomy to slow down bone loss and even treat breast and uterine cancer. Studies have shown that your risk of developing breast or uterine cancer while using Estriol over extended periods of time is much lower.  That means, you have a lower risk of female cancer than that of the general public while on Estriol. 

I have had excellent results preventing hot flashes, night sweats, osteoporosis, mood swings and cardiovascular disease in both menopausal and hysterectomied women with the natural Estriol.  My patients go to bed at night sleeping much easier knowing that they no longer have the higher risk of cancer  now that they are using a natural plant hormone.

What About Progesterone?

Progesterone is androgen like testosterone, a male hormone.  Progesterone and testosterone are both important in balancing estriol in menopausal women.  Almost all my patients are given a little natural progesterone to keep their natural estriol balanced.  A very few are given some testosterone as well.  In my 22 years of testing menopausal women, I have found that most women are deficient in progesterone, more so than estrogen.  Progesterone, not only works as well as estrogen in reducing menopausal symptoms, it builds new bone whereas estrogen only reduces bone loss.

Testing for Female Hormones

For over 20 years, accurate saliva testing has been available for all the sex hormones.  All the hormones flow though all the cells of the body, including salivary cells.  Thus, measuring saliva provides a window into the cell of a woman to find out how many hormones are actually making it into her cells.  When estrogen and progesterone were first discovered, physicians tried measuring these hormones in the blood.  They did NOT find a correlation between the level of hormones in the blood and menopausal symptoms.  A woman could have normal estrogen in her blood but have terrible hot flashes.  Consequently physicians had to forego measuring the actual hormone in the blood and be satisfied with measuring the pituitary hormones called FSH and LH which stimulate the ovaries to make estrogens and progesterone.  If FSH and LH were quite high, a women was going through menopause.  But there is no value doing this test for determining how much estrogen to give during menopause.  All you can do is tell a woman she is going through menopause, not how much estrogen or progesterone you can safely give her. 

To determine a safe level of treatment, a physician must determine, how much hormone is actually low in the menopausal women’s cells, provide that hormone and then monitor the level on a regular basis until it is no longer needed.  This is where saliva testing comes in.  By collecting a small amount of saliva, a woman’s estrogens, progesterone, and testosterone can be measured, INSIDE THE CELL.  Now the physician has an accurate way of determining how much hormone to give and for how long. 

 It is interesting to know what saliva testing has shown us over these last 20 years.  Using saliva methods we have found that most women actually make plenty of estrogen during menopause, but very little progesterone.  Consequently, I prescribe mostly natural, bio-identical progesterone which helps reduce hot flashes and night sweats as well as mood swings and vaginal dryness.  In only 20 percent of cases is the estrogen low.

 Types of Sex Hormones Prescribed

There are two types of bio-identical hormone delivery systems available, capsules and sublingual drops.  The advantages to capsules are the ease of dosing, just one capsules down the hatch twice a day usually.  The disadvantage to capsules is that over 50% of the hormone is wasted by the liver and some can be converted to other hormones which may be undesirable.  The advantage to sublingual drops is that they are almost completely absorbed through the large veins under the tongue and therefore do not convert to other hormones.  What you take is what your body gets.  Another advantage is that the dosage can be more easily increased drop by drop than capsules.  A third advantage is the cost, drops are significantly less expensive than capsules.  The disadvantage to drops is you must place several under your tongue twice a day, using a mirror to accurately count the dose, not quite as easy as taking a capsule. 

Sex and Menopause

Does menopause mean the end of sex?  Menopause means the end of fertility not the end of sexuality.  Some women report less sexual desire and greater time requirements for sexual arousal but others report no difference in desire or function after menstruation ceases.  Vaginal dryness can be a problem leading to pain during intercourse.  Until your estrogen levels can be normalized vaginal secretions will be minimal and friction high.  Using lubricants during sex such as water soluble K-Y jelly can really help.  If the problem is severe a natural Estriol vaginal cream should be used daily. 

Some women lack a sexual companion at this time in their lives either because of death, divorce or lack of available men.  Some of these women masturbate for sexual pleasure.  If there is guilt associated with this act, it may helpful to know that most people masturbate and that the practice is helpful in facilitating sexual responsiveness.  Masturbation has helped people during a period when they had no desirable sexual partner.

 Menopause and Mood Swings

Are the hormonal shifts at menopause responsible for the depression and anxiety of some menopausal women or are they the result of stresses created by the incidental entrance of the menopausal women into the new challenges in her life?  These two theories have been argued by psychologists for years and so far there is more evidence for the latter theory.  There is no peaking of emotional illness in women during their 40's or early 50's.  The only clearly associated symptoms to hormone level shifts are hot flashes and night sweats.  On the other hand it is true that during menopause women taking estrogen will experience relief from hot flashes, vaginal dryness and night sweats which make their anxiety easier to deal with thus creating the illusion that the estrogen had directly relieved their anxiety.

Osteoporosis

Women often ask me whether estrogens really prevent osteoporosis.  Estrogen, besides stimulating many physical characteristics of being female, improves calcium absorption from our food or supplements and drives calcium into the bone. Consequently, estrogen is one important factor of calcium mineralization of the bone.  If the bone is under-mineralized then women gradually become deformed, their backs curve unnaturally forward as the weight of their body becomes too much for the soft bone tissue to support.  They develop dowager's humps on their backs and many break their hips or other bones, which heal very poorly and slowly.  Unfortunately, many medical doctors, as poorly educated in nutrition as they are, act as though giving synthetic estrogens to post-menopausal or post-hysterectomized women is the answer to osteoporosis.  It is not. 

Women who take synthetic estrogens do in fact break bones if they are deficient in calcium.  What doctors don't understand is that women are severely deficient in calcium for the following reasons: 1)  As a women ages her stomach production of hydrochloric acid becomes lower and therefore her ability to break calcium out of food and supplements goes down;  2)  The calcium that MD's routinely prescribe is calcium carbonate which is only 10% absorbed and actually neutralizes stomach acid!  This can lead to a difficulty in breaking down proteins and cause indigestion and gas;  3)  There is a low soil content of Boron, a mineral important for keeping calcium circulating long enough in the blood for the estrogen to drive it in.

Consequently, the best way to prevent osteoporosis is to eat foods rich in calcium.  These foods include dairy products and green leafy vegetables.  If you tolerate dairy products, the most easily digestible products for middle aged adults are cottage cheese and yoghurt.  Only 1/2 cup cottage cheese contains 14 grams of protein and 155 mg of calcium, a sensational food!  Taking pills is not the solution, they are not as well absorbed as the calcium from food, no matter what the source.  To hedge your bets, you should still supplement with calcium pills but be certain to use the right forms.  NEVER use hard tablets.  Tablets are the worst form, they are poorly broken down.  Make sure that your supplement does not contain stearates, stearic acid, magnesium stearate or other form, these chemicals prevent absorption of calcium.  To obtain an easy to absorb form of calcium, use calcium citrate which is 80% absorbed even if there is little stomach acid.  Always take magnesium with calcium as they are both important in providing good bone density.  The right ration is 1 to 1.  Equal amounts of calcium to magnesium should be consumed.  Boron is another important ingredient for good bone density.  Boron will keep the calcium circulating in the bloodstream long enough to get into your bones.  Your multiple vitamin mineral supplement should contain at least 3mg of boron for your bone needs.