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Menopause

• Before we get too far into this, let's assume you already have a few basic facts about hormones.

• And secondly, look on the bright side: Once you're through it PMS is GONE, emotions stabilize and don't swing all over the map, bleeding is over, water weight fluctuations are gone, much of the food cravings are gone, and many women experience a freedom in their pysche that's remarkable.

In Screaming to be Heard, Dr. Elizabeth Vliet writes, "Our marvelous ovaries and their hormones are intimately linked to ALL our body systems… every cell, tissue and organ we have! Estrogen alone is involved in over 400 functions in a woman’s body. Is it any wonder, then, that women have a whole host of problems when their ovarian hormones go awry whether following a pregnancy, tubal ligation, hysterectomy, or during the perimenopause and menopause years?"

• Here's a short pdf covering her discussion of our hormonal activity.

But look, it's probably going to start a lot earlier than you think. Our mothers expected hormonal changes in their early 50s, 'cause when they asked, that's what their mothers told them. No one else really discussed it at all, certainly not their doctors. In fact, hormones start the decline much earlier as we begin what's now known as perimenopause.

According to Project Aware, "Perimenopause is the phase before menopause actually takes place, when ovarian hormone production is declining and fluctuating, causing a host of symptoms. Some clinicians maintain that perimenopause can last for as long as 5 to 15 years, while others refer to perimenopause as that period which is a 3 to 4 year span just before menopause. Either way, many women experience more symptoms during perimenopause than after menopause. Because this often happens at an age between 35 and 45, many women's symptoms are overlooked or ignored by their healthcare providers"

The 35 Menopause symptoms -- too many of them! -- top ten in order of frequency:

Hot flashes, flushes, night sweats and/or cold flashes, clammy feeling
Irregular heart beat
Irritability
Mood swings, sudden tears
Trouble sleeping through the night (with or without night sweats)
Irregular periods; shorter, lighter periods; heavier periods; phantom periods, shorter, longer cycles
Loss of libido
Dry vagina
Crashing fatigue
Anxiety, feeling ill at ease

Number one complaint (even if not the most serious): hot flashes, which are caused by the hypothalamic response to declining ovarian estrogen production stimulating release of luteinizing hormone (LH). High pulses of LH have vasodilatory effects, which leads to flushing. The Breastcancer.org site, concerned about cancer patients who may need to keep estrogen low, suggests the following natural methods for fighting hot flashes:

Discover and avoid your personal triggers, which are often stress, alcohol, caffeine, diet pills, spicy food, hot tubs and saunas, hot showers, hot rooms or beds, hot weather and smoking. To diminish hot flashes and ease other menopause symptoms like depression and mood swings:

Get regular excercise
Avoid highly spiced foods, large meals, hot drinks, caffeine and alcohol
Use stress reduction techniques like yoga
Drink lots of water
Wear loose clothing in easily removable layers
Sleep in a cool room

The site also notes that eighty-five percent of the women in the United States experience hot flashes of some kind as they approach menopause and for the first year or two after their periods stop. Between 20 and 50% of women continue to have them for many more years. As time goes on, the intensity decreases.

• An overview of the risks and benefits of hormone replacement therapy is here.

• And here's a breakdown of some of your options should you decide against HRT.

You may also want to consider use of soy products and other herbal options such as black cohosh, which works quite well in relieving symptoms in many women, although women who have had breast cancer or are considered high risk probably should not take it. A few years ago Evening Primrose Oil was thought to provide menopausal symptom relief, but the evidence apparently didn't back up the initial hopes.

• Super Spectrim offers an herbal menopause support that works quite well as a non-prescription option.

Depression and mood swings are common with decreasing estrogen and testosterone. You may decide against hormone replacement, but may still need to address quality of life for you (and your spouse, family and friends!). Antidepressants called Selected Serotonin Reuptake Inhibitors (SSRIs) work to increase the amount of serotonin in the brain (serotonin is the hormone that regulates mood), and there are new medicines coming on the market regularly. Antidepressants work, and are nothing to be embarrassed about; a prescription may be needed for a year or two to ease you through this life-change process. Don't get discouraged and give up if the first medication doesn't work for you -- again, trial and error over four-to-six week tests will find the one that will work for you, and when you find it, it'll feel like magic when the dark cloud lifts.

Vaginal dryness is common with decreased estrogen, causing itching or painful intercourse. Vaginal estrogen treatment (weekly estrogen tab or the new "ring" insertion) does not pass through the organs and is considered completely safe and fully effective.

Managing menopause begins with research and knowledge, medical history evaluation, your doctor's input (or maybe *another* doctor's input!), your personal decision making, and finally, a whole lot of trial an error. Quality of life is a vital element in your decision, and what worked for your friends may not be working for you; you may also need to spend more time than seems fair in finding a doctor who has both the time and the knowledge to discover your best options.

There's a hefty, but not too scientific discussion of hormone replacement therapy, complete with details of the WHI study, here at the Mayo Clinic site.

Many researchers and doctors believe estrogen replacement therapy is dangerous medicine, especially after the Women’s Health Initiative (WHI) and Heart and Estrogen/progestin Replacement Study (HERS) study was stopped in 2002 due to excessive heart problems in the hormone-receiving participants of the double-blind research. However, there's now some controversy over that, because the study used the estrogen (brand: Premarin) derived from the urine of horses, and a synthetic progestin (brand: Provera), not identical to anything our natural hormones.

• Here's another aspect of the study findings and how to taper off hormones should you decide to go that route. At this point it's unknown whether bioidentical hormones would have provided the same results.

• This article explains natural vs synthetic hormones.

Here's a list of the most common hormone replacement dosages for women, and here's a full breakdown of HRT products, but keep in mind, lower doses can be used to temper down symptoms for short duration. Full dose is not the only route for relief.

Compounding pharmacies prepare creams and gels that are usually considered safer HRT delivery, although some women do not get the same results as they do with oral medications. Here's a list of compounding pharmacies should you wish to test that option.

In addition to estrogen, much-needed testosterone goes on the decline at about the same point in our lives. Many women don't know how necessary this once-considered "male" hormone contributes to our confidence, mood and sense of well being. There's some concern over oral ingestion testosterone (pills, which travel through the liver), and luckily new modes of delivery are hitting the market.

• Dr. Elizabeth Vliet explains the new options here in The Savvy Woman's Guide to Testosterone, and writes, "Testosterone is as natural to women as estrogen. It is not just a man’s hormone. From a woman’s teens until menopause, her body makes more testosterone than estrogen! Testosterone is crucial to a woman’s health and well-being. Loss of testosterone can cause loss of sex drive and sexual sensation, marked fatigue, low energy, hair loss, decreased stamina, loss of height, and other symptoms."

There's a serious concern about estrogen replacement with some medical histories, primarily if your mother had breast cancer under age 50, or, of course, of you've had breast cancer. You'll find more on that topic here at Project Aware and here at Breastcancer.org.

Visit imaginis.com for more study on menopause, discussion of hormones, cancer and the most recent HRT news, and of course, pick up Dr. Elizabeth Vliet's comprehensive book on women's hormones, Screaming to be Heard.

Finally, and most importantly, take whatever time you need to study and test the best options for you. For some, it's a matter of good life vs bad for you and your family... literally for years. Relax, don't worry about symptoms you may not even get and don't sweat the small stuff. Laugh in the face of your hot flashes and you'll have a much easier time passing through this stage of your life.