A Physical and Psychological Change
When does the Menopause begin?
Experience of the Menopause varies
Conventional Medical Help for
Menopausal Symptoms
Alternative Medical Help for
Menopausal Symptoms
Vitamin and Mineral Supplementation
Phytoestrogens and Phytoprogesterone
Coming to Terms with the Menopause
The term ‘menopause’ is used in the technical sense to refer to the ending of menstruation, or monthly periods, but in general use it embraces a wide range of symptoms that accompany the climacteric, or change of life. This normally occurs in a woman’s life between the early forties to the mid-fifties, and usually lasts two or three years. During this time, the ovaries stop producing eggs, and fertility declines and eventually ceases.
Several psychological factors are related to the process of physical change. A woman may experience fear of losing her attractiveness, uncertainty about her purpose in life as a middle-aged woman, sadness at the passing of the fertile prime of life. These feelings may even outweigh the physical discomfort caused by the complex hormonal changes.
In some women, menstruation may stop suddenly, with no previous change in the cycle being experienced. However, in most women, the menstrual cycle becomes irregular. Periods often become less heavy and occur farther apart, but they may also occur more frequently, or follow the usual timing, but miss some out. Bleeding or spotting between ‘normal’ periods, after sexual intercourse, or which occurs a year or more after the last period should always be brought to the attention of a medical practitioner promptly.
During the menopause, the ovaries reduce and eventually cease production of eggs and oestrogen, the hormone responsible for female reproductive function. Some oestrogen is still produced in other parts of the body, notably in the layers of fat beneath the skin, therefore plumper women often experience fewer effects.
Loss of oestrogen causes symptoms such as hot flushes, night sweats, a reduction in lubricating fluid in the vagina, and a need to pass urine more frequently. About 70% of women suffer these symptoms in varying degrees during menopause.
There is a gradual but progressive loss of bone mass, or ‘osteoporosis’, which leads to a greater risk of fractures in later life, particularly hip fractures. After the menopause, lower oestrogen levels cause a reduced protection against heart attacks.
Women experience hot flushes or ‘flashes’ in varying ways, and to varying degrees of severity. Some women experience them only as night sweats, where they awake in the middle of the night, their whole body covered in sweat, throw off the sheets, cool down and go back to sleep. Other women may experience hot flushes anywhere at any time, for example, when driving a car on a long journey, going into a confined area, such as an aeroplane, or being in a social situation, such as a dinner party. The symptoms can range from feeling extremely hot and needing to drink cold water and stand in fresh air, to an acute sense of anxiety.
During the menopause, women may suffer anxiety, irritability, mood swings, poor concentration, insomnia, and depression. These symptoms may be exacerbated in women whose children have grown up and left home, who may not be engaged in work outside the home, and who consequently suffer an acute loss of identity.
Women who have never previously experienced anxiety may start to do so at this point in their lives. Things that they have done routinely for years, e.g., driving a car, travelling by plane, participating in social interactions, leaving the house to pursue daily activities, such as shopping, going to work, etc., may suddenly become either very difficult or impossible. This can be extremely distressing and confusing because, not only do they have to cope with these new anxieties, but they also have to face the repercussions of them. So, for example, not being able to drive a car might mean that a ten-minute car journey becomes a one-hour journey by public transport; not being able to travel by aeroplane might mean they are unable to take a holiday abroad with their family or friends; not being able to leave the house means that they may not be able to shop or even go to work.
An additional difficulty is the problem of feeling unable or actually being unable to talk through such problems with friends, family or colleagues. Women who have not previously suffered from symptoms of anxiety, and have felt relatively emotionally stable up to this point in their lives, may find the unfamiliar symptoms very frightening and overwhelming. It is very important to talk about these problems openly, and get support from close family and friends.
Women’s experience of the menopause varies greatly. Some may suffer debilitating physical and/or psychological symptoms, while other experience relatively little discomfort and/or few psychological disturbances. Some women feel fit during the menopause, and may welcome the cessation of the nuisance of monthly periods, and the ability to enjoy their sex life free from the need for contraception. Vaginal shrinkage and dryness are lessened by an active sex life.
The conventional medical treatment for menopausal problems is Hormone Replacement Therapy, or HRT. Women on HRT have continued monthly bleeding, but without an egg being produced each month. Some women experience a vast improvement in menopausal symptoms, such as relief from hot flushes and vaginal dryness, improvement in skin tone, increased energy and a lifting of depression.
Women are usually given oestrogen tablets to take over either three or four weeks of the menstrual cycle. If nausea or diarrhoea is experienced, oestrogen pellets, which release small amounts of oestrogen continuously for up to six months, can be implanted under the skin, under anaesthetic. Alternatively, oestrogen is also available in the form of creams, pessaries and stick-on skin patches.
Most women are also given another hormone, progesterone, which is taken in tablet form for one or two weeks of the cycle. This counteracts overstimulation of the womb lining, a major side effect of HRT, which may increase the risk of cancer. Women who have had a hysterectomy are given oestrogen only.
The major benefit of HRT is the protection it offers against osteoporosis and the risk of hip, wrist and spine fractures. Some studies have shown that HRT can protect against heart disease and strokes, through the action of oestrogen, although other studies have indicated an increased risk of these, possibly through progesterone. However, one of the main drawbacks of HRT is the slightly increased risk of some cancers. HRT is not advised for women with a history of cancer of the breast or uterus, a family history of breast cancer, or undiagnosed vaginal bleeding. A thorough case history and medical examination should be carried out by a medical practitioner prior to HRT being prescribed. Women on HRT should receive regular medical check-ups, and report any symptoms such as headaches, dizziness, pains in the calf muscles, breast lumps, or an unusual vaginal discharge.
Many menopausal symptoms will be helped with a healthy, balanced diet, regular exercise, sufficient sleep, and the use of relaxation techniques. Cleansing diets, aromatherapy, acupuncture and homoeopathy may all help to alleviate symptoms.
Vitamin and mineral supplementation is a safe alternative to HRT. Vitamin B helps to counteract symptoms of anxiety, insomnia and fatigue. Vitamin C is important for tissue repair and iron absorption. Vitamin D is needed to aid absorption of calcium, an essential mineral supplement during menopause. Vitamin E helps prevent cardiovascular disease. Calcium helps to maintain bone health and to prevent osteoporosis. Magnesium is needed for efficient calcium utilisation. Evening Primrose Oil contains Gamma Linoleic Acid, which is important for cell generation, and Prostaglandin E1, which regulates the action of many hormones.
Herbal supplementation is also a safe and effective alternative to HRT. Camomile tea and lime-blossom tea may be taken as relaxants. Passiflora tablets may help to relieve tension and anxiety. Hot flushes may be alleviated by liquid Sarsaparilla, Ginseng tea, Life Root, Dong Quai and St John’s Wort. St John’s Wort is also effective in relieving symptoms of depression. Agnus Castus contains prostaglandins (hormone-like compounds), and can be used at the beginning of the menopause for hot flushes. Black Cohosh also helps to alleviate hot flushes, and can reduce vaginal atrophy and depression.
Certain plant foods and herbs, such as Soya, Wild Yam, and Dong Quai, contain phytochemicals, known as phytoestrogens and phytoprogesterone, which have hormone-like properties. Many women find Wild Yam to be very successful in the treatment of menopausal symptoms, as it contains phytoprogesterone, which helps to regulate hormone imbalance. Wild Yam also contains DHEA, a substance identical to a hormone produced in the adrenal glands of mammals, and the most abundant steroid in the plasma of healthy humans. Higher levels of DHEA protect against obesity, atherosclerosis and cardiovascular disease. Dong Quai contains phytoestrogens, which may exert a regulating effect on oestrogen levels, and thus help to regulate hormone imbalance.
Other herbs that may help in the treatment of menopausal symptoms include: Avena Sativa, Dandelion, Liquorice, Blue Cohosh, Hawthorn, Motherwort, Blessed Thistle, Sarsaparilla, Squaw Vine and False Unicorn. Some herbal supplements may suit an individual more than others, and therefore experimentation may be required to find the most effective ones.
Many women dread the approach of
the menopause. It is an extremely
significant period, not only because it heralds the end of fertility, but
because in many societies it is symbolic of a woman ceasing to be a woman in
the fullest sense of the word. Women
are under so much pressure from the media and advertising, etc., to stay
constantly young and sexually attractive, that when a woman starts to
experience peri-menopausal symptoms, she finds it difficult to face up to the
changes that her body is going through, and the fact that this is the beginning
of the menopause.
It is important to get support
from other women who are going through or have been through the menopause,
because, however much a woman does not wish it to happen to her, it is
essential to come to terms with this change.
Many women find that once they have gone through the menopause, it no
longer holds the symbolic significance that it did, and they often feel exactly
the same as they did before, physically, sexually, emotionally, and mentally.
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