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