THE CHALLENGES OF MENOPAUSE

1. Hormonal Changes with Menopause

Hormones are our body’s messengers that travel through the blood stream to start, stop, speed up or slow down our physical and chemical functions and processes across all body systems. The ovaries are the source of estrogen and progesterone, the two key hormones that control the reproductive system, including the menstrual cycle and fertility in women. Estrogen and progesterone are regulated by two other hormones produced by the pituitary gland, i.e. Luteinizing Hormone (LH) and Follicle-Stimulating Hormone (FSH). We are born with all the eggs we will ever have stacked in our ovarian follicles. During menopause, the follicles decline in numbers and the ovaries become less responsive to LH and FSH leading to a decline in estrogen levels. These inevitable hormonal changes during menopause can significantly affect our health for years to come. Menopausal symptoms are temporary and their duration depends on your lifestyle and the ability of your body and beliefs to support you through this period of transition. Because all symptoms are interrelated, the treatment of one symptom may alleviate other symptoms as well. Hot flashes and night sweats These most common early signs of menopause are an outcome of hormonal changes. Their intensity and duration can be magnified by external factors such as anxiety, tension, a diet high in simple sugars and refined carbohydrates (abundant in fruit juices, cakes, cookies, candy, white bread, etc.). Brain and Nervous System Estrogen depletion can bring on a combination of hormonal and biochemical fluctuations that can upset our brain and nervous system, such as mood swings, memory loss, problems in focusing, irritability, fatigue, hot flashes, night sweats, stress, anxiety, etc. Reproductive System Reproductive ability decreases with age due to the loss of ovarian function and estrogen depletion, after the end of the monthly menstrual cycle and ability for conception. The vagina also becomes drier and irritable with possible inflammation and infection as outcomes of the thinning and shrinking of the tissues, along with a decrease in lubrication. Urinary System Estrogen depletion can cause the lining of our urethra to become drier, thinner and less elastic, leading to an urge to urinate more often, higher risks of urinary tract infections and incontinence when coughing, laughing or lifting heavy objects. Bones Beyond age 30, a reduced rate of creating new bone mass ma no longer keep up with the rate of bone loss in our body. During menopause, estrogen depletion further increases the risk for low bone mineral density, osteopenia, and osteoporosis followed by a gradual weakening of our bones and increased risk for fractures and other injuries.

Menopause - 1 Skin Estrogen appears to help the water-holding ability and elasticity in the skin and its ability to heal when wounded. Reduced estrogen can lead to dryness, itching, wrinkling, sagging, and higher susceptibility to injury, such as bruising. Heart problems Menopause can also cause abnormal heart rhythms like atrial fibrillation. Slower heartbeats induce dizziness, but more commonly, faster heartbeats will be felt as agitation. Heart Palpitations may be frightening, but are rarely dangerous, as they are the result of imbalances between the sympathetic and parasympathetic nervous systems and are often related to fear and anxiety. In addition, Heart and blood vessels respond to significant drops in estrogen by becoming stiffer and less elastic with a tendency for hypertension that can place added strain on the heart. Shortage of estrogen can also cause unwanted reduction in HDL cholesterol and rise in both LDL cholesterol and Triglycerides. These changes tend to increase the risk of heart disease, especially among those having experienced an early menopause or having undergone hysterectomy (removal of uterus) or oophorectomy (removal of ovaries). Diabetes Menopause increases the tendency for insulin resistance with reduced capability to convert blood sugar into energy for cells to use. This increases the risks for diabetes, heart disease and stroke. Weight gain With estrogen shortage during menopause, metabolism and the burning of fat slows down, thereby contributing to weight gain, with associated higher risk of heart disease and diabetes.

2. Hormones Replacement Therapy (HRT)

The role of estradiol, one of four components of estrogen, diminishes after menopause from that during the childbearing years. Before menopause, estradiol stimulates maternal behavior and physiology toward childbearing and childcare including growth in the breasts, ovaries, uterus and maturation of egg- bearing follicles. Throughout post-menopausal years, the ovaries and other secondary hormone production sites continue to produce smaller amounts of estradiol that can be sufficient to support optimal health. This estradiol production capability, however, is compromised by chronic stress, unmet spiritual/emotional needs, and cultural condition about menopause as being the age of “despair”. To make up for this reduction in production, doctors prescribe HRT to push our physiology back to pre- menopausal time as a way of treating menopausal symptoms such as hot flashes, vaginal dryness, heart palpitations and irritability. HRT, however, is not without some serious health risks to be borne in mind: • Blood clots in legs and lungs with possible stroke, similar to birth control pills, patches and rings. These risks increase with age especially if you take oral hormones by mouth, as opposed to transdermal application, i.e. through a patch, gel, or spray. • Risks of breast and uterine cancers increase with longer HRT duration, especially for 5 or more years. The risk decreases after HRT is stopped. There is no proof yet that hormones biochemically identical to our own hormones are any safer or more effective than current synthetic hormone therapies. Yet, there is a consensus that non-hormonal therapies should be the first approach in managing menopausal symptoms for all women, especially those who have survived breast cancer.

Menopause - 2 3. Natural Remedies for Menopausal Symptoms

Research has confirmed that women who exercise, don't smoke (or quit), and eat a healthy, nutritious diet rich in fruits and vegetables substantially reduce their risk of disease as they age. Mood Swings Hormone fluctuations in perimenopause can create feelings of helplessness, irritability, anxiety, fatigue, blue moods, and even depression. To regain self-control and acquire a stable sense of serenity, practice relaxation and stress-reduction techniques, such as deep-breathing exercises, massage, a healthy lifestyle (good nutrition and daily exercise), and enjoyable, self-nurturing activities. Clinical hypnotherapy and mindfulness meditation can also help improve certain menopausal symptoms such as hot flashes. Try to stay away from long-term use of antidepressant medications, aimed at correcting hormonal imbalances. Their effect may be short-lived and they should only be taken temporarily in conjunctions with counseling or psychotherapy to achieve long-term benefits and independence from any medications. Urinary Incontinence An involuntary loss of urine may be considered as an unfortunate and unwelcome annoyance. Try drinking adequate water to keep urine diluted (clear and pale yellow), and avoid foods or beverages with high acid or caffeine content, which could irritate the bladder lining. Examples are grapefruit, oranges, tomatoes, coffee, and caffeine-containing soft drinks. Also try Kegel exercises to strengthen your pelvic floor muscles and reduce incontinence episodes. Night Sweats For a relief from hot flashes during sleep, try to stay cool while you sleep: • Dress in light nightclothes. • Use layered bedding that can easily be removed during the night. • Cool down with an electric fan. • Sip cool water throughout the night. • Keep a frozen cold pack under your pillow or put a cold pack on your feet. • Avoid spicy foods, caffeine, and alcohol that could trigger hot flashes. Trouble Falling Asleep Establish a regular sleep schedule and sleep routine: • Fix the time to go to bed times and to wake up for all weekdays. • Relax and wind down before sleep by reading a book, listening to music, or taking a leisurely bath. • Take milk and peanuts before bedtime. They contain tryptophan, which helps relax your body. • Sleep in a dark, quiet, and cool bedroom. • Use the bedroom only for sleep. • Avoid caffeine and alcohol late in the day. Sexual Discomfort Try one or more of these to deal with vaginal dryness and a decline in sexual function: • Water-soluble vaginal lubricants: Avoid potentially irritating products such as oil-based lubricants (e.g. Vaseline) and hand creams and lotions containing alcohol and perfumes. • Vaginal moisturizers used on a regular basis for a more lasting effect.

Menopause - 3 4. Nutrition for Menopause

Good nutrition can help prevent or ease certain conditions that may develop in menopause. Foods for Menopause Symptoms • Soy foods (such as soy nuts, soymilk and tofu) are modestly effective in relieving hot flashes. Soy contains phytoestrogen, which work in the body like a weak form of estrogen to partially make up for the estrogen decline in menopause. • Flaxseed and its oil are good sources of lignans, which tend to balance female hormones and thereby help with mild menopause symptoms, such as night sweats. • Black Cohosh root has been used for centuries for decreasing hot flashes, night sweats, and emotional liability. It is widely used in Europe as an alternative to HRT for relieving depression, vaginal dryness, and menstrual cramps. Recent research suggests that black cohosh does not act like estrogen, and accordingly does not pose a similar threat to hormone-sensitive tissues such as uterus, breast. It has been recommended however not to be used in the case of any liver problems. • Ginseng can help with mood swings and sleep disturbances, but not necessarily with hot flashes. • St. John's Wort can smoothen mood swings, especially when combined with black . • Licorice root has multiple health benefits including estrogenic, anti-inflammatory, anti-allergy, antibacterial, and anti cancer effects. It could help regulate estrogen/progesterone ratios. Use supplements with Caution Most of the herbal and plant supplements are not regulated and their manufacturers are not required to report any problems or negative outcomes. The amount of herbal product, quality, safety, and purity may vary between brands or even between batches of the same brand. Herbal therapies may also interact with prescription dugs and change the effect of the botanical, the drug, or both. In comparison, whole foods/herbs show better results than capsules or pills containing isolated ingredients. They contain many different active ingredients that act synergistically in the body. Herbs work best when taken as part of an overall plan that includes diversified diet, exercise, and stress management. Foods for bone and body health in menopause Because the risk of osteoporosis development rises after menopause, we will need to target more foods that support bone health, such as the following. • Beyond 50, women need 1,200 mg of calcium a day. Calcium-rich foods, include dairies, Tofu, Molasses, and Dark green leafy vegetables, such as bok choy, Chinese cabbage, kale, collard greens, and turnip greens. Dark greens provide vitamin K, which is also needed to support bone health. Tofu is high in Isoflavones, which are shown to help in bone health. As examples of calcium content in food, half a cup of calcium-enriched Tofu contains > 400 mg, whereas one cup of cooked turnip greens has ~200 mg, and one tablespoon of Molasses contains ~40 mg, making it a god substitute for sugar. Calcium supplements are problematic as they can raise the risk for heart attacks in some people. If you need supplements, take smaller doses with food during the day for a better absorption. • Vitamin D is just as essential as calcium for bone health, as it facilitates calcium absorption. Older people need 800 IU daily, to be obtained from both food and sunshine exposure, which induces the body to produce its own vitamin D. But extended sun exposure could lead to skin damage, and it’s

Menopause - 4 best to get the exposure early morning or late afternoon. Fatty fish (e.g. salmon) are high in vitamin D, as well as calcium and omega-3 fatty acids known to support bone health. A 85-gm serving of canned contains ~180 mg of calcium coming from the soft bones blended with the meat in the canning process. If taking vitamin D supplements do not go beyond 4,000 IU each day, to avoid harming the kidneys and weakening the bones. • Magnesium and potassium are also needed for bone health. Magnesium deficiency can upset our vitamin D balance, whereas Potassium neutralizes acidity in the body to prevent leaching calcium out of the bones. One medium-size sweet potato contains ~30 mg magnesium and ~540 mg potassium. Figs are also rich in potassium and magnesium, as well as calcium (~20 mg in one medium fresh fig or 120 mg in half a cup of dried figs). • Vitamin C (mainly from citrus fruits) is needed to prevent bone loss. One whole pink grapefruit has ~90 mg of vitamin C, providing the daily required amount, whereas one navel orange has ~83 mg. • Bioflavonoids compete with excess estrogen for receptor sites and are safer alternatives to HRT. Bioflavonoids-rich foods include soy, fresh ground flaxseed, several whole grains, herbs, nuts, grape skins, and the berry family of fruits (cherries, cranberries, blueberries). Soy protein, in particular, noticeable benefits in relieving menopausal symptoms as well as protecting the heart and bone, when taken in sufficient amounts; 100-160 mg of soy Isoflavones per day. Examples of servings that contain ~35-50 mg of soy Isoflavones include 1 cup soy milk, ½ cup tofu, ½ cup tempeh, 3 handfuls of roasted soy nuts.

5. Wisdom and Empowerment of Menopause

Menopause may feel like the logical side of the brain going dormant for a while to help us become more intuitive and more in tune with our emotions and inner wisdom. You are just rewiring your brain for a whole new way of thinking. Wisdom and Power of Elder Women The elder women may have more sensible ideas about honoring and conserving life on this planet than those who currently rule. Native societies used to celebrate the aging woman as a source of help and guidance for their future generations. Until we learn to once again live by the perceptions and insights of the feminine experience, we will remain alienated from some of the best products of the human mind. When an older woman taps into her inner soul (her fundamental spirit), she connects to an unending and credible power. When such power is unleashed, strange and wonderful things can happen for our struggle against both fear and grief. If I slip through my skin, my flesh, my blood, my bone down and down into the soul space, I will see a garden there full of dormant and unattended bulbs and seeds of self. That’s the time to water this Garden and remove its . It needs so much care to make it fertile again. That is what will awaken the core of my being; else I wither into my “old woman’s” skin. Without embracing the biological, emotional, mental, and spiritual transformations available in my life’s experience, menopause can become a barrier against achieving my new realm of being. Men have their own inner spaces, but they are more like caves with many rooms within. To enter this cave, we would have to knock or be invited in. But the invitation will only come, when men hit a phase in their life, that they would begin taking a similar journey. And the man who can’t handle such phase will often reach for a younger woman. If he has difficulty accepting the aging process and death, an older woman is a reminder to him that it’ coming.

Menopause - 5 Our deepest fear is not that we are inadequate; it is that we are powerful beyond measure. It is our light, not our darkness, that most frightens us. We ask ourselves: “Who am I to be brilliant, gorgeous, talented, fabulous?” There is nothing enlightened about shrinking so that other people won’t feel insecure around us. We were born to manifest the glory of God that is within us. It is not just in some of us, it is in everyone, and as we let out own light shine, we unconsciously invite other people to do the same. As we are liberated from our own fear, our presence automatically liberates others. How a woman knows it’s time to go to her own garden? If she didn’t know, because she hasn’t been listening to her dreams or inner guidance, then an outer wakeup call is needed. It could come in the form of a divorce, an accident, a tragedy, a loss or even restlessness. Somehow she begins to feel that sense of longing that there is something greater to be done with her life. To reach a place of fullness, you have to do the inner work. Two or three years before you go into menopause, you should be in transition, a bridging time. Prepare to get the tools of wisdom, to meditate, to go on a retreat, or to take a day of silence. The New Hero’s Journey A modern version of the traditional hero’s journey is to face what we fear and find out who we are. When we have the courage to actually be who we are, then we transform our personal kingdom, and the ripple effect helps to transform the larger kingdom. If people fail to do that, but instead they get into performance or trying to measure up or do what advertising says or what the manager, or some therapist, or the church says. With this, they end up being a good copy of somebody else and there is an empty space where their own unique gifts could be. Menopause is a call to find out what is true and real about you as a mature woman. It is a soul journey to explore new lifestyles or new ideas and find out about things you didn’t know before. You might feel a little restrained from taking this journey by the status quo, the demands to conform, and the limitations of culture or consensual reality. To take the first step, you might then need to connect with people who have new and different ideas. Women often experience a loss of some physical abilities during this point in their lives. We may be conscious of tiring more easily, and therefore let go of trying to be all things to all people, all the time. So, our task is to prioritize and get clear about what it is we most care about doing. As we let go, we will be disconnecting from what we have loved and reconnecting to new things that now satisfy us more. Or it can be reconnecting to old things in a new way, transforming the experience of letting go from a problem into an opportunity. It is like that we die to one small thing and get reborn to more glamorous things. So it is up to us whether to take menopause as a great tragedy that our life is no longer worth anything or as a transition into a deeper way of living. Behind all creative life is the divine spirit, the breath of God, or the life force of all that exists. It is what can widely open our heart, an inspiration that can descend to shake up or rekindle in us with something that has been put off or was never there before. Inspiration comes only to those who yearn for such a guest with a wide-open heart. We can invite it in many different pathways; art, poetry, love of beauty, devotion, or more effectively servitude to the needy. It is best to seek someone who knows and has gone before on the pathway, not someone who guesses and surmises without a true knowledge.

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