The Natural Menopause

(by a female holistic practitioner)

What exactly is the Menopause?

Most of the time we use the word “menopause” incorrectly. Strictly speaking it refers to the last menstrual period - the moment when menstruation stops. (It is the counterpoint to the “menarche” when the periods begin.) The transition period of ongoing changes and adjustments which we usually refer to as the menopause, is officially known as the “climacteric”. This is divided into three phases:

The pre-menopause – the early years, usually from age 40, when hormonal changes take place but may be hardly noticeable – although women may experience a changed menstruation pattern and occasional hot flushes.
The peri-menopause – function of the ovaries declines and periods become irregular – the time when most physical changes are noticed.
The post-menopause – from the time of the last period (identified in retrospect) until the end of a woman’s life.

For the sake of easy reading, however, I will continue to use the word “menopause” here as per its normal usage.

The menopause tends to get a ‘bad press’, with a proliferation of horror stories about the terrible symptoms it brings. Many people (including doctors) see it as an illness to be treated. But it is a natural gradual process whereby a woman’s body moves out of the childbearing years and into a (hopefully) liberated and more relaxed phase of life. The anthropologist Margaret Mead said that her own experience was of giving up PMS (pre-menstrual syndrome) for PMZ: post-menopausal zest! Not everyone finds it a positive experience, however. The transition entails many physical changes, which also have a mental and emotional effect, and in some women this can be severe.

To understand what happens at menopause, we need to understand the body’s normal menstrual cycle, which is regulated by the ovaries.

The Menstrual Cycle

The menstrual phase – Days 1-5 – the uterus sheds its lining (endometrium).

The follicular phase – Days 6-12 – follicle stimulating hormone (FSH) is sent by the pituitary gland to the ovaries, to stimulate growth of new follicles. As they grow, they produce estrogen and eventually the FSH level drops. By Day 7 one follicle survives above the rest and the others decline.

The ovulatory phase – Days 13-15 – estrogen reaches its critical level and this signals to the brain to release luteinizing hormone (LH). The surge of LH causes the follicle to burst and expel an egg (ovulation). The egg moves towards the uterus via one of the fallopian tubes. (If conception takes place, it is usually at this time.)

The luteal phase – Days 16-22 – the now empty follicle reforms into a structure called the corpus luteum. This is responsible for producing progesterone which continues to rise for the rest of the cycle. Progesterone prepares the uterus for pregnancy by thickening the endometrium.

The premenstrual phase – Days 16-28 – if fertilization does not occur, the corpus luteum disintegrates and there is a rapid decline in both estrogen and progesterone over about 4 days. Withdrawal of progesterone causes the endometrium to break down and it is shed during the menstrual period (back to Day 1).

In the years leading up to menopause, the ovaries become less responsive to follicle stimulating hormone and luteinizing hormone, and gradually slow down as the egg supply dwindles. Eventually ovulation stops altogether. Production of progesterone ceases and much less estrogen is manufactured. Until menopause the ovaries are the primary source of estrogen and the drop in this hormone affects the body in many ways (although the rate and extent of symptoms varies from woman to woman). The following are some of the physical changes which gradually occur, due to lack of estrogen and/or an imbalance in the overall hormonal mix (NB female hormones also include testosterone):

Genital organs gradually become smaller, elasticity of pelvic muscles is reduced and vaginal membranes become drier (thus vagina is more prone to infection).
Breast tissue can lose fullness and firmness.
Skin may become drier and hair thinner.
Bone density decreases and this may lead to an increased risk of osteoporosis.
Cholesterol levels rise in the blood (estrogen and progesterone are both made from cholesterol) so that post-menopausal women carry a similar risk of heart disease to men.
Body shape changes with a tendency to accumulate more fat around abdomen and hips (not entirely bad news since fat cells contain estrogen!).

Some estrogen remains in the body and the adrenal glands become important as estrogen-manufacturers.

A premature menopause – one that happens before the age of 40 – can be caused by a number of factors: if the supply of egg cells in the ovaries is used up, very poor nutrition, extreme stress, hysterectomy with or without removal of ovaries.

The Menopause – Some Interesting Facts and Theories

Average age of menopause in Britain is 51 (but 45 – 55 is normal).
Heavy smokers are more likely to experience an early menopause.
Tall women and fat women often experience a later menopause.
Women who suffer PMS tend to have a slightly later menopause and are more prone to problem symptoms such as hot flushes and irritability.
Women with fibroids may have later menopause due to high estrogen levels.
A hysterectomy can accelerate the onset of menopause by about 5 years.
Poor nutrition and exceptional stress can bring on an earlier menopause.

Symptoms of the Menopause

The hormonal changes produce many different symptoms. Physically, many women experience hot flushes, night sweats, sleep disturbances, fatigue and loss of libido; some may experience aching joints, constipation, breast tenderness, itchy skin or increased facial hair (due to higher testosterone balance). Some women have very mild symptoms for only a few weeks or months; in others they may be severe and/or last for 5 - 10 years.

Psychological symptoms include depression, poor memory, anxiety and irritability. These may be exacerbated by life changes happening at around the same time: children growing up/leaving home, job changes/retirement/redundancy, long term relationship stress or marriage breakdown.

It is likely that people’s expectations of menopause, attitudes towards ageing, level of self-esteem, and degree of contentment with life before menopause influence the degree to which they experience negative symptoms. Women who eat healthily and exercise regularly appear to have more positive experiences of menopause.

Conventional Treatment for Menopausal Symptoms

The menopause is a natural process; however, many people, including doctors, treat it like a disease which needs to be cured. Certainly some of the above symptoms will be excessive and unpleasant for some women, and warrant relief. Conventional allopathic treatment has largely focused around replacing lost estrogen, and/or treating women for depression.

Estrogen Replacement Therapy was developed in the 1930s (as injections and pellet implants) and by the 1960s was hailed as a cure-all breakthrough which would keep women ‘forever young’. In the intervening years, side effects and new research (for instance, documenting a rise in endometrial cancers in ORT users) prompted the development of Hormone Replacement Therapy (HRT) which delivers synthetic progestogen as well as estrogen. Continued research has induced caution, and most doctors now prescribe HRT for only 5 years or so, although some women take it for longer. Nowadays HRT is - in theory - customized to suit a woman’s needs and minimize side effects, and it is available in many forms: tablets, pessaries, skin patches, creams and implants.

The medical justification for prescribing HRT is that it will protect bones from osteoporosis and the heart from heart disease. However, there is a slightly increased risk of breast cancer, uterine cancer and blood-clotting disorders; therefore HRT contra-indicated for anyone with a family history or tendency to these. And while some menopausal symptoms are lessened on HRT, side effects may produce other unwelcome symptoms.

Side effects occur because the hormones are synthetic (manufactured) and thus not recognized by the body in the same way as those produced naturally. The hormones in HRT are similar to those in the Pill, varying by dose and chemical structure. The estrogen in HRT comes largely from pregnant mare’s urine (trade name Premarin): although ‘natural’ in origin, not all oestrogens in the mixture are natural to humans. Synthetic progestogens are more likely to cause mood swings and depression than our own natural progesterone. The Physician’s Desk Reference used by doctors in the USA lists the following as possible side effects for HRT: endometrial cancer, weight gain/loss, breast tenderness, bloating, depression, thrombo-phlebitis, high blood pressure, reduced carbohydrate tolerance, reduced glucose tolerance, skin rashes, hair loss, abdominal cramps, vaginal candidiasis (thrush), jaundice, nausea, vomiting, cystitis or similar symptoms.

Another point worth noting is that while estrogen continues to be manufactured in the body after menopause (albeit in smaller quantities), progesterone production ceases altogether. As a supplement it is therefore more likely to disturb the body’s natural balance.

‘Natural’ Progesterone

In recent years there has been a surge of interest in ‘natural’ progesterone, usually in the form of a topical cream (sometimes produced from diosgenin, an estrogen precursor found in the wild yam). This came about mainly to counteract estrogen dominance from the onslaught of xeno-oestrogens (environmental estrogen-type substances, usually of petro-chemical origin and found in plastic packaging etc).

There is a theory that progesterone also protects bone density and there is some evidence of osteoporosis being reversed from progesterone and/or estrogen supplements. However, many women experience severe mood swings and depression similar to PMT symptoms.

Overall, there are two main reasons not to take hormonal supplements:

None of them are identical in molecular structure to that normally manufactured in the human body.
The more artificial hormones we put into our bodies, the less the body will continue to make its own hormones. When HRT is stopped, the adjustment process will have to begin all over again, and it may be much harder to encourage natural estrogen production.

An Holistic and Natural Approach to the Menopause

Optimal Nutrition

Food is medicine! The right diet will relieve symptoms, support the endocrine system and promote good health throughout the menopause. It will assist the body to adjust itself to change and keep the hormones more balanced. The main aims should be to:

Stabilize blood sugar levels: to enable remaining hormones to be fully utilised. Large gaps between meals are likely to lead to hypoglycemic symptoms such as irritability, forgetfulness, palpitations etc. When glucose levels fall too low, the adrenal glands release adrenalin and the pancreas releases glucagons to increase blood sugar. At this stage people often seek a quick boost in the form of a sweet snack. The surge in blood sugar requires the pancreas to produce insulin and puts further strain on the adrenals. Repeated strain on the adrenals can impair their proper functioning. They can be supported by regular intake of complex carbohydrates (eating little and often) and avoiding simple sugars which are metabolized too quickly.

Increase water intake and avoid addictive foods and drinks: to help stabilize blood sugar and avoid build-up of toxins. Alcohol, tea, coffee and chocolate contain stimulants which strain the adrenal glands. They can also contribute to hot flushes, tiredness, anxiety and panic attacks. Caffeine has a diuretic effect which flushes vital nutrients out of the body. Tannin binds important minerals such as calcium and prevents their absorption. Alcohol is a toxin which strains the liver, depletes the body of vitamins and minerals (especially zinc), and interferes with the metabolism of essential fatty acids which are needed to produce prostaglandins – the chemicals which help to control moods, immune response and hot flushes. The body needs plenty of plain water to function smoothly.

Reduce intake of dairy products (bio yogurt excepted) and red meat: to help balance hormones and promote effective digestion. Red meat is high in phosphates which encourage release of calcium from the bones, thus increasing the risk of osteoporosis. Dairy products are acid-forming and mucus-forming. They tend to have a high saturated fat content which can encourage arteriosclerosis and high blood pressure. Both meat and dairy products are difficult and slow to digest, using up precious energy. They can putrefy in the gut, interfering with absorption of vital nutrients. (Organic yogurt with live bacteria is an exception because it is beneficial to gut flora.)

Include essential fats: to build cells, keep skin and arteries supple, balance hormones. Essential fatty acids are part of the unsaturated group of fats. They are needed by the body on a daily basis and are found in nuts, seeds, oily fish and vegetables. Omega 3 oils are especially helpful in menopause as the body uses them to produce prostaglandins, which lower blood pressure, decrease sodium and water retention and reduce blood platelet stickiness, thus protecting against heart attacks and strokes. They are also important for immune function, metabolism, and skin repair, and are found in oily fish, linseed, pumpkin seeds, walnuts and dark green vegetables. Evening primrose oil has a balancing effect on the hormones and can reduce PMT.

Increase dietary fibre: to balance blood sugar levels, prevent constipation and improve elimination of toxins. The best sources of fibre are whole grains, fresh fruit and vegetables.

Reduce sodium: to balance water retention and blood pressure. This is best achieved by reducing table salt intake and avoiding processed foods which often contain added salt (and sugar). Sodium is kept in balance by potassium, so it is important to reduce alcohol, coffee, sugar, diuretics and laxatives which flush out potassium from the body.

Increase intake of phyto-oestrogens: to support hormonal system. These are a group of foods containing substances that have a hormone-like action (e.g., soya bean protein is 75 percent isoflavones). The body can convert these to compounds which have a mild estrogenic action and fit onto estrogen receptor cells. This can help block harmful xeno-oestrogens, and also inhibit the development of cancer cells. Studies have shown phyto-oestrogens to reduce the level of FSH to pre-menopausal levels, alleviating vaginal dryness and reducing hot flushes. As well as soya (especially tofu and miso), other sources are red clover, linseed oil, fennel, celery, parsley, citrus fruits.

Balance micro-nutrients: to ensure an adequate supply of essential vitamins and minerals. A diet high in fruit and vegetables should supply most of these and “eating the rainbow” is a good rule of thumb, since different colored vegetables contain different essential nutrients. However, some vitamins are lost during storage and cooking, and some soils are depleted of certain minerals. Anti-oxidants, such as Vitamin C, combat free radicals to alleviate the signs of ageing and should be taken daily. Vitamin E (found in olives, avocados, beans and wholegrains) reduces the risk of heart disease and can counteract dry skin and vaginal dryness. B vitamins can reduce anxiety and fatigue. A multi-vitamin/mineral supplement may sometimes be necessary, especially during stressful times and to boost the immune system.

Check out food intolerances: to relieve bloating, IBS, skin problems and severe menopausal symptoms. Many people in Britain are intolerant to wheat and/or dairy foods without realizing it.

Eat garlic and onions daily: to boost the immune system, protect against cancer and combat infection.

Eat the most natural foods possible: avoid plastic packaging (xeno-oestrogens interfere with the body’s hormonal receptors), eat organic to decrease intake of chemicals and artificial hormones, buy fresh local produce where possible – or grow your own!

Natural Remedies

There are many useful herbal remedies which can ease menopausal symptoms and support the body to adjust. The main ones are:

Agnus castus - stimulates and normalizes the function of the pituitary gland, and restore hormone balance.
Black Cohosh - used by native Americans, also supports pituitary gland and reduces fluid retention.
Dong Quai – (often thought of as the female equivalent of ginseng) alleviates vaginal dryness, regulates periods and reduces hot flushes.
Yarrow – can lower the body temperature, so alleviates hot flushes and night sweats.
Dandelion – has a detoxifying effect so supports the liver in eliminating ‘old’ hormones and built-up toxins. Also reduces fluid retention.
Wild Yam – helps balance hormones and has anti-spasmodic qualities so useful to relieve period pains and muscle/joint problems.
Motherwort – alleviates vaginal dryness, helps calm anxiety, reduces hot flushes, helps combat insomnia, relieves pain.
Sage – combats flushing, especially night sweats.
Red Clover – a rich source of phyto-oestrogens.
Evening Primrose Oil – a rich natural source of gamma-linoleic acid, encourages healthy skin and helps hormonal balance, reduces PMT and menopausal stress.

Herbal teas can also help: for instance, peppermint to calm digestion, chamomile to soothe and relax, fennel to combat constipation.

Aromatherapy is very helpful, using the diluted essential oils of plants. These can be used in massage, as an alternative to perfume or in a relaxing bath. Geranium combats fluid retention, is pain-relieving and has a balancing effect on the hormones; clary sage is an anti-depressant; bergamot is calming and pain-relieving; lavender regulates menstruation, soothes headaches, encourages relaxation and is sleep-inducing; jasmine and rose are uplifting, relaxing and soothing to skin; rosemary and lemongrass are energizing.

Massage, Shiatsu and Acupressure can all be helpful in encouraging relaxation, highlighting imbalances and increasing self-knowledge about our body’s needs.

Chinese medicine views menopause as a deficiency of kidney and spleen qi (life energy) which slow down as we age. The reproductive organs are ruled by kidney qi, and spleen qi is linked to metabolic rate. The usual treatment is a course of herbs combined with bodywork such as acupuncture, massage, tai chi or yoga.

Homeopathy is helpful (best to consult a qualified practitioner), as are Bach flower remedies. “Rescue Remedy” comes in small portable bottles and has an almost instant anxiety-relieving effect.

Exercise is one of the best therapies of all. Even 30 minutes per day of brisk walking, yoga, swimming or dancing (preferably a mix of different activities throughout the week) can be a wonderful anti-depressant since the brain releases endorphins (“feel-good” chemicals). It also encourages flushing of toxins and lymph drainage; promotes good balance and coordination; promotes healthy elimination of waste; improves lung and heart capacity; maintains muscle tone; and builds and maintains bone density.

Sexual activity is also very important. Sex with a trusted partner or self-pleasuring (preferably to orgasm but not necessarily) maintains circulation to the sex organs, stimulates the endocrine glands, encourages libido, promotes lubrication and eases congestion. It is a case of “use it or lose it”! Seeing oneself as desirable sexual being also promotes self-esteem and dispels negative images of ageing.

Positive Ageing

Menopause is likely to be easier if a woman has a high level of self-awareness and is in tune with her body’s needs. We need to love ourselves and love our bodies, and treat them with the respect they deserve. Many women have spent their lives giving to others and have not learned to receive. This is a time to enjoy treats such as massage and explore the many new therapies available. It is also a good time to explore new spiritual paths if that is not already an integral part of life. There is evidence that people with a rich spiritual life age more happily and live longer.

Building self-esteem and enjoying life will help to promote a positive approach to life as an older person. It will also encourage us to build healthy (non-dependent) relationships. In the West, there is a youth culture and the focus of the menopause is usually on loss. We can learn from other societies where women only achieve status as an individual at this time, and later life is seen as a time of wisdom, maturity and valuable experience. Many healers and advisors are older women. Post-menopause can be a wonderful time to explore new freedom, develop as an individual, tear down old boundaries, redefine our roles and goals, and celebrate new achievements.

How Reflexology Can Support the Menopause Experience

Regular reflexology treatments can support a menopausal woman physically, mentally and emotionally. It can help a woman tune into her body’s needs, highlighting imbalances and areas which need attention. It can provide a safe space in which to relax, receive and be self-focused. Having an empathic reflexologist who understands the physical changes behind menopausal symptoms and takes her problems seriously can, in itself, relieve stress.

Click here for a listing of UK reflexologists

Click here for my Reflexology and Reiki practice located in Somerset and serving Frome, Bath, Bristol, North Dorset, Wiltshire and Bradford-on-Avon, Trowbridge and nearby areas.

The treatment should focus on:

Stimulating the endocrine system: Adrenals (very important after menopause as hormone providers). Also pituitary (regulates other glands), thyroid and parathyroid (to balance calcium and phosphorus levels and regulate metabolism). Ovaries (to regulate hormone production) and uterus (to maintain its circulation). Head/brain area to stimulate hypothalamus (stimulates pituitary and controls body temperature) and pineal gland (body rhythms, sleep patterns). Lower spine to support reproductive area.
Promoting elimination and fluid balance: liver (to detoxify toxins and regulate body heat), kidneys (to filter blood and balance body fluid), lymphatics (encourage lymph drainage), colon and rectum (to regulate bowel habits).
Boosting the immune system – lymphatics, spleen, thymus gland.
Boosting self-esteem – solar plexus (calming, supporting, promotes positive self-image and boosts willpower).
Supporting emotional balance: heart and cardiac area (to release emotional tension and promote positive energy in heart chakra).
Relieving stress: use lots of moves which promote relaxation – chest and diaphragm to ease breathing; neck, occipital, shoulders, joints, spine to release tension.

Finally, good active listening and counseling skills can help to encourage a positive approach to menopause. The reflexologist’s suggestions about diet and lifestyle may increase the client’s understanding of the menopausal process and the factors which exacerbate her symptoms. This kind of support can help her to lose bad habits and make lasting changes.

For a guide to the best sex after 50, post menopause for women, and post andropause for men, click on the link.