by Dr. Carolyn DeMarco and Dr. Zoltan P. Rona
Menopause is a natural event in every woman's life. It is not a "deficiency disease," a "deterioration," an "estrogen starvation" or a long list of other archaic, patriarchal medical labels. It is a process of change and transition as a woman's body sheds its childbearing potential and adjusts to lower levels of hormones. Menopause starts around the late forties when periods start to get more irregular and finally stop altogether at an average age of 50 (earlier in black and non-European women). In the healthy female, once the ovaries stop producing the female hormones, the adrenal glands eventually produce enough hormones to maintain balance. During this transition period, hot flashes, vaginal dryness, depression, loss of libido and other menopausal problems prompt women to visit their doctors.
Doctors disagree about whether all menopausal women should he on hormones or whether hormones should he reserved for women with severe hot flashes, vaginal dryness or those at high risk for hone loss and heart attacks. Some prescribe synthetic estrogen with or without progesterone to all their menopausal patients. Others, however, maintain that only rare women should be prescribed synthetic hormones and that symptoms can he controlled entirely by natural means. Doctors also disagree about the length of time hormones should he taken. The extremist pharmaceutical view holds that menopausal women should he on hormones until death.
Despite the grandiose claims of the drug lobby, there is little evidence to support the use of estrogen for the prevention of heart disease, osteoporosis or any other disease. Long term studies on the effects of estrogen and progesterone on healthy postmenopausal women have never been done. A recent editorial in the New England Journal of Medicine puts it this way: "Since the long term safety of hormone replacement therapy has not yet been fully elucidated, there is need for other effective therapies for the prevention and treatment of osteoporosis."
Low estrogen is hut one of 40 factors involved in the development of osteoporosis. Exercise and vegetarian (low protein) diets have been shown to he far more important for osteoporosis prevention. Other major risk factors for osteoporosis development are cigarette smoking, excessive alcohol and caffeine intake, having a fair complexion, having had the ovaries removed or other causes of early menopause, a positive family history of osteoporosis, never having been pregnant, dings such as cortisone, diuretics (water pills), anti-seizure medications and anticoagulants ("blood thinners"), digestive disorders and overactive endocrine glands (especially hyperthyroidism).
Some of the many negative effects o ['estrogen replacement therapy during the menopause include abnormal Pap tests, abnormal bleeding with resulting iron deficiency, candida (yeast) infections, circulation problems, high blood pressure, abnormal blood clotting (thrombosis), migraines, strokes, increased coronary artery disease risk, weight gain and fluid retention. Some women who take prescription estrogens complain of acne, skin colour changes, bloating, a loss of libido, depression and an increased sensitivity to light. Others complain of menstrual pattern changes, chest pain, difficulty breathing, eye pain, vision changes, a loss of coordination, increasing breast lumps and painful urination.
The use of estrogen hormone by itself is associated with a three to four times increased incidence of uterine cancer. To lower the potential cancer risk, doctors usually add a progesterone prescription For 10 days out of every cycle. Unfortunately, this causes menopausal women to continue bleeding monthly after the menopause which continues as long as she is on hormone replacement therapy. Other common side effects of progesterone therapy include migraines, bloating, breast tenderness and depression.
Hormone replacement therapy is linked to an increased risk of breast cancer. According to Dr. Sidney Wolfe and a 1991 article in the Journal of the American Medical Association, "If a woman used estrogen pills for 15 years, she had a 30% excess rate of breast cancer. If used for 25 years, a "goal" toward which many doctors are pushing t heir patients, t here would he a 50% increased risk of breast cancer..." Women have now been exposed to both long term hormone treatment in the form of the birth control pill and long term hormone treatment in the form of estrogen replacement. No one really knows what the combined effect might be on the intricate workings of the female reproductive system. There are several ongoing studies to evaluate the specific interaction hut the results won't be available for ten to twenty years. Many doctors feel that medicating a natural life process with potentially toxic drugs cannot be justified on the basis of some very questionable research. Certainly, there are no safety and efficacy studies which are conclusive enough to warrant the wide scale drugging of a normal, healthy female population.
Menopausal symptoms can he controlled naturally and without any significant side effects. Osteoporosis and coronary artery disease can be prevented and even reversed by diet and lifestyle changes alone. The ideal diet for menopausal women is vegetarian. There are many reasons for this, the major one being that animal proteins with their high phosphorus contents cause the body to lose large amounts of calcium and other minerals. For more information on vegetarian diets, a list of studies that support this type of diet in osteoporosis/heart disease prevention and treatment, see "Diet for a New America" and "May All Be Fed" by John Robbins.
Most menopausal symptoms, including hot flashes can he treated successfully with supplemental vitamins, minerals and herbs. Some herbs contain estrogenic substances but at levels of estrogen activity 4(X) times less than pharmaceutical compounds. These include dung quai, licorice, black cohosh, a long list of soya products and fennel. Other herbs that are helpful for menopausal symptoms include damiana, raspberry, sage, Siberian ginseng and gout kola. Several food supplement companies make combinations of these herbal remedies (e.g. St. Francis Herb Farms, Nature's Sunshine, Enrich International, etc.). Natural vitamin E also contains (races of estrogens making it an ideal menopausal supplement. The same can he said about brewer's yeast.
Dr. John Lee has found the use of a natural progesterone cream (Pro-Gest - available from Gahler Enterprises at your local health food store) which is applied to the skin will prevent hone loss even without the addition of estrogen. Pro-Gest cream is derived partially from an extract of wild yams and has no toxic effects.
In women who cannot go off synthetic estrogens for real or imagined reasons, vitamin E (400 IU - 1200 IU daily) and evening primrose oil capsules (6-9 capsules daily) will help prevent some of the circulatory complications of synthetic estrogen therapy (e.g. abnormal blood clotting, etc.).
Bioflavonoids are plant substances that exist together with vitamin C in nature. They prevent estrogens from being broken down too rapidly in the hotly thereby avoiding some of the unpleasant hot flash symptoms. Bioflavonoids are abundantly available in citrus fruits, garlic, onions, peppers, cherries. currants, buckwheat and many other foods. In supplemental form, look for bottles containing rutin, hesperidin, catechin, quereetin or pycnogenol on your health food store shelves.
Vaginal dryness and itching during menopause can he controlled by using vitamin E cream or calenctula in flaxseed cream (e.g. Flora Distributors). Melhrosia (2 capsules 3 times daily). bee pollen (2 to t2 capsules daily) and boron (2 mgs. 3 times daily) are other natural supplements that help women with libido and hot flashes during the menopause. Boron supplementation, for example, raises serum estrogen levels. One study demonstrated (hat boron supplementation produced estrogen blood levels identical to estrogen treated women whose diets were not supplemented with boron. Boron supplementation does not pose the same cancer-causing risks as synthetic estrogen replacement therapy (e.g. uterine or breast cancer). It is non-toxic. For a personalized program of diet and supplements, consult a natural health care practitioner.
Dr. Carolyn DeMarco writes for the general public on a regular basis and is the author of Take Charge of Your Body: A Women's Guide in Health. Since obtaining her degree from the University of Toronto in 1972, she has specialized in women's health. Dr. DeMarco has been a pioneer in natural childbirth and raising public awareness about the overuse of drugs and surgery in women's healthcare. She has lectured on women's health throughout Canada and the U.S. and has frequently been interviewed on both radio and television.
Zoltan P. Rona, M.D., M.Sc. is a graduate of McGill University Medical School and has a Master's Degree in Biochemistry and Clinical Nutrition. He is the author of The Joy of Health. A Doctor's Guide to Nutrition and Alternative Medicine and is a past president of the Canadian Holistic Medical Association. He is currently in private medical practice in Toronto and has a regular advice column in Alive magazine.
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