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* Symptoms of Menopause *
Some women remember hearing about menopause from their mothers, aunts, or older friends. Others may have read about the general physical process and seen personal stories in women's magazines and newspapers or heard them on the radio or television. A smaller contingent may have even attended a full-day seminar or weekend retreat on the topic, where women shared their personal journeys and discussed facts about menopause, facts they had gone to great lengths to obtain. Whatever your source of information, you probably have a fairly good understanding of the physiology, possible symptoms, and general happenings of menopause. Still, let's just cover a few of the basics.
Menopause is the time of life when a woman's ovaries wind down and production of the hormones that have been pumping out with regularity for forty or more years slows down. For certain women, it is a smooth and relatively innocuous transition, but others find the ride somewhat bumpy, accompanied by any number of uncomfortable symptoms.
When the ovaries age or when they are removed in an operation, the female hormones-particularly estrogen-that keep the female body and brain functioning are no longer produced in the same amounts. In the absence of adequate quantities of estrogen, a woman may start to experience some of the following symptoms:
* anxiety * backache * depression * difficulty sleeping * discomfort or pain during intercourse * dry skin * dry vagina * headaches * hot flashes * increased facial hair * irritability * itchy skin (as if insects are crawling on the skin) * joint aches * lack of sexual drive * light-headedness * loss of concentration * mood swings * muscle aches * poor memory * tiredness * urinary stress incontinence
Menopausal symptoms often start a few years before a woman's periods stop altogether; during this time, referred to as perimenopause, the symptoms are at their most severe. Sometimes periods quit abruptly, but more commonly they are sporadic, wavering between heavy and light until they finally stop completely. When periods have ceased entirely for a year, a woman is said to have reached menopause. Symptoms vary from none to severe among individual women, and they may last from a few months to several years. The average age of menopause is around fifty, but it can range anywhere between ages thirty-five and fifty-nine.
Hot flashes are the most distressing symptom reported by women in Dr. Liew's practice. In mild cases, women report a wave of heat creeping up the trunk, neck, and face for a few minutes. Some also complain of severe sweating following a hot flash-this can occur twenty to thirty times a day. At night, these severely affected women have to change their pajamas or nightclothes a few times because of the sweats, and they are invariably unable to tolerate any blankets, whether it's summer or winter.
Another noted symptom is loss of libido (interest in sex), which can go hand in hand with dryness of the vagina, making intercourse uncomfortable and irritating. Often estrogen replacement alone is not enough to improve lack of sexual desire, but it definitely helps with vaginal lubrication, eases the symptoms of vaginitis, and decreases the risk of recurrent bladder infections. Plant estrogens, when eaten regularly for a few months, can help moisten a dry vagina, making sex more comfortable. Other symptoms, such as mood swings, irritability, and insomnia, may also respond quite well to estrogen supplementation.
Some complaints, although listed as symptoms of "menopause syndrome," may be the result of other medical conditions that are totally unrelated to menopause, but do occur more frequently in middle-aged and older people. These symptoms should be assessed and investigated on their merits, especially if they are distressing or disrupting your life. Two conditions that appear to affect middle-aged women more than other age groups are thyroid disorders and anemia.
Menopause and Hormone Replacement Therapy
Every woman (if she lives long enough) eventually goes through menopause. Some women sail through this phase of their lives without any problems, but a significant number require varying degrees of intervention and possibly even medical help with the multiple complaints associated with this time of life.
Hormone replacement therapy (HRT) may be the only answer for a certain number of women going through menopause. For these women, symptoms such as unbearable hot flashes and night sweats, an uncomfortably dry vagina, and roller-coaster mood swings may be alleviated only by HRT. For those whose lives have been drastically altered and their quality of life greatly diminished, medical treatment may indeed be the best option. There is no reason to suffer unduly during the menopausal years. Furthermore, it's well known that female hormones are inextricably linked to bone health, and thus HRT should be considered for those who are clearly at risk for osteoporosis. Recent research suggests that estrogen also enhances brain function and may be used to prevent and treat Alzheimer's disease in women. A large observational study carried out over the course of ten years in Cache County, Utah, reported that HRT use was associated with a significant reduction in the risk of Alzheimer's disease. At the time of the study, 72 percent of the study participants were using estrogens only while the rest were using combined HRT. Other randomized clinical trials (RCT) of estrogens also reported varying improvement in the mental functions of treated participants. Unfortunately, these trials were small and short in duration. A large RCT that was designed to study the effects of estrogen (Premarin) on mental function and cognitive aging in postmenopausal women is expected to be completed in 2005.
On 28 May 2003, the authors from the Women's Health Initiative Memory Study reported that their randomized control trials of combined estrogen and progestin (Premarin and Prempo) had detected a two-fold increase in the risk of probable dementia (including Alzheimer's disease) in the HRT group when compared to the placebo group. This translates to an extra 23 cases of dementia per 10,000 women per year of HRT usage. It is not known if this increased risk is due to the progestin component of the HRT, as the results certainly contradicted those reported in previous observational studies and clinical trials.
Yet, the benefits of HRT may outweigh the risks for a number of women, in which case it should be seriously considered.
Benefits of HRT
* treats unbearable symptoms of menopause (hot flashes, dry vagina) * preserves the bones and prevents osteoporosis * may lower the risk for colon cancer * has a questionable benefit in the prevention and treatment of Alzheimer's disease
But nothing works for everyone, and so it goes with HRT. Some women are unable to tolerate outside hormonal intervention in any form. It has been estimated that up to a third of women who start HRT discontinue it for one reason or another. (Recently, the WHI study reported a 42 percent discontinuation rate of the combined HRT.) One obvious reason for stopping treatment is the number of uncomfortable and unwanted side effects.
Common Side Effects of HRT
* fluid retention * headaches * irregular vaginal bleeding * irritability * nausea * sore breasts * venous thrombosis * weight gain
A significant number of women simply cannot take HRT because it is contraindicated. This means that they currently have medical conditions that could be worsened by the addition of hormones. If you suffer from any of the following, HRT is not for you.
Contraindications of HRT
* deep venous thrombosis and/or pulmonary embolus * endometriosis * hormone-dependent cancers such as breast cancer, ovarian cancer, or endometrial (uterine) cancer * impending surgery requiring immobilization * liver disease * undiagnosed vaginal bleeding * uterine fibroids
Hormone replacement therapy during and after menopause greatly helps some women, but it's clearly not for everyone. Before you make the all-important decision to take or not take HRT, learn all you can about it, and know its risks as well as its benefits.
Potential Risks of HRT
* aggravation of preexisting hormone-dependent cancers * deep venous thrombosis and/or pulmonary embolus * increased risk of breast cancer * increased risk of uterine cancer * increased risk of coronary heart disease * increased risk of stroke
In recent years, some menopause clinics have reported (in their observational studies) that HRT use by women after successful breast cancer therapy did not adversely affect their survival. Three clinical randomized trials to study the effects of HRT in patients with previous breast cancer are underway, but the results may not be available for quite some time yet. Until we are sure that HRT definitely will not cause harm to this group of women, the majority of doctors will probably not prescribe it for their breast cancer patients.
Plant Hormones Lessen Menopausal Symptoms
A lowered estrogen level is said to be responsible for many of the symptoms of menopause. While this is too simplistic an explanation for the entire anthology of menopause-related complaints, it is true that a number of disturbing feelings may accompany declining production of female hormones.
A host of researchers have noted that a common factor links women's diets in countries where women in midlife are free from menopause-related complaints. These women eat plant foods containing estrogen-like substances that augment natural estrogen in their bodies. Laboratory tests have also shown that estrogen-like substances in foods can, in fact, have a marked influence on women's hormone status and general health.
Certain plant foods, ingested in sufficient amounts, contain enough plant estrogens (phytoestrogens) to elevate hormonal levels and curtail menopausal symptoms. When estrogen levels are low, a daily dose of specific foods eaten at a meal or as a snack may provide just enough of a boost to ward off hot flashes, moisten vaginal tissue, and even out mood swings.
Food substances that simulate hormone activity in the body are called phytohormones, but in reality they aren't true hormones such as those produced naturally by our bodies. Phytohormones can affect estrogen activity directly, or they can provide precursors to substances that later promote estrogen activity. Phytohormones may have differing effects, depending on a woman's natural hormonal level at the time of ingestion. They can stimulate estrogen production if levels are too low, and they also can reduce hormone levels if they are too high. This property is referred to as hormonal modulation, and it is evident in herbs such as dong quai and panax ginseng. Phytoestrogens (particularly the subcategory known as isoflavones) compete with the body's natural estrogens by attaching themselves to estrogen receptor sites (alpha and beta) on cell surfaces when there are excessive amounts of estrogen in the body, thereby reducing the potent effect of naturally produced estrogens on sensitive tissues such as the breasts and uterus. In an estrogen-deficient state, when there are more empty estrogen receptor sites, phytoestrogens occupy the empty sites and behave like weak natural estrogens. Phytoestrogens can do this because their chemical structure closely resembles that of natural estrogens.
Literally hundreds of plants contain estrogen-like substances. Some foods contain more potent phytoestrogens than others. Studies have shown that soy, flaxseed, rye, clover, and chickpeas (garbanzo beans) are among those with the most potent hormonelike effects. The foods listed on page 18 contain one or more of the phytoestrogen groups, which are called isoflavones, lignans, and coumestans. (See the Appendix for a diagram illustrating how some of the different phytoestrogens are grouped in relation to each other.) This list is by no means complete; further research is being carried out all the time.
How Phytoestrogens React in a Woman's Body
How phytoestrogens work is still somewhat perplexing. They appear to have contradictory effects in women's bodies, depending on one's age and how much estrogen the body makes naturally. When a woman's estrogen levels wane, as in menopause, phytoestrogens exert estrogen-like activity and raise the estrogen level in the body's tissues; paradoxically, when a premenopausal woman generates high levels of estrogen, these same phytoestrogens block some of the natural estrogen from entering the cells, thus protecting against unhealthy exposure. Not only can phytoestrogens treat menopausal symptoms that result from declining estrogen levels, they also may protect against breast and uterine cancers, which are thought to be promoted by continuing exposure to high levels of estrogen.
It is thought that estrogen-like substances from plant sources bind to estrogen receptor sites within the body, thus reducing the effects of the low-estrogen state characteristic of menopause. Even though such proestrogenic activity is very weak (from 1/400 to 1/1,000 the strength of women's natural estrogen), the boost may be enough to circumvent symptoms.
Phytoestrogens' effect on female tissues depends on many factors: the two most obvious are the amount of estrogen a woman's body is already producing and the saturation of her receptor sites. If natural estrogen is sufficient or elevated, then phytoestrogens compete for status on the receptor sites. If they successfully replace the natural estrogen that our bodies make, they are thought to protect us from unhealthy levels of one type of estrogen, estradiol.
This information has helped to explain observational studies of postmenopausal Asian women, who have not only fewer menopausal symptoms but also a lower rate of breast cancer. Significant amounts of excreted phytoestrogen byproducts have been found in the urine of Asian women, from ten to one hundred times more than in that of Americans. Indeed, some researchers consider urinary excretion of plant estrogens a better indication of the health benefits such as reduction of cholesterol, blood pressure, and hot flashes than other types of laboratory tests. High urinary excretion of phytoestrogens suggests adequate consumption, bacterial transformation, and absorption of phytoestrogens. In other words, the amount of phytoestrogens present in the urine tends to predict how much you'll benefit from eating phytoestrogen-rich foods. (A minority of people, however, are unable to absorb or benefit from phytoestrogens despite eating large amounts of phytoestrogen-containing foods. These people are considered nonresponders.)
Studies on the incidence of breast, colon, and prostate cancers among Asians and residents of Western countries have suggested that the incidence of these cancers is linked to diet. Migrant Asian populations that adopt a Western diet-high in fats and low in vegetables and fiber-have a much higher incidence of these cancers than do the populations in their native lands. A typical Asian diet includes 30 to 100 milligrams of phytoestrogens daily; the Japanese consume up to 200 milligrams of phytoestrogens per day. Europeans and Americans take in a paltry 1 to 5 milligrams of phytoestrogens daily.
Properties of Soy Proteins
Phytoestrogens in general, but particularly those found in soy foods, contain specific hormonelike substances called isoflavones. This large class of compounds (there are well over four thousand) occurs naturally in plants and can be further subdivided into more specific types, including daidzein, genistein, formononetin, and biochanin A. One of these, genistein, is considered the most powerful within this class of isoflavones and seems to be generating the most interest among food scientists, especially for its role in cancer therapy. Many ongoing studies are evaluating exactly how it works in human health.
Excerpted from The Natural Estrogen Diet & Recipe Book by Lana Liew LINDA OJEDA Copyright © 2003 by Lana Liew. Excerpted by permission.
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