Menopause: the wrong kind of warm

Hot flashes—perhaps the most dreaded symptom of menopause, and the most common as well. Menopause is defined as the stopping of the menstrual period for at least 12 consecutive months. The average age for menopause is 51, and in the US 1.3 million women reach this milestone every year. Many women experience only mild discomfort, but others are not so fortunate.

Is menopause a medical condition?

Before reviewing some of the changes post-menopausal women can experience, it’s important to state that menopause is a natural event in a woman’s life and is therefore not a type of medical pathology[i].

 This does not mean that menopause is always uneventful; rather, it means that for some women the symptoms of menopause exceed the threshold of discomfort, understandably driving them to seek outside help. As well, certain symptoms if left to progress unchecked can represent a significant threat to health.

There are many factors contributing to the “medicalization” of menopause. An important one is attitudes toward aging and the high value placed in our society on youth, especially when it comes to physical appearance. This acts on older women in a way that’s similar to how societal definitions of “thinness” act on body-image for young women and girls. We are continually bombarded with messages telling us that age represents a deficit or disability, instead of an asset. This can drive some women to seek drugs, supplements or surgery in order to regain their youth, rather than embrace their age. There are several books on this topic that can assist women to better understand and address their own attitudes and feelings about the aging process[ii].

Other life-cycle changes often occur at the same time as perimenopause (the time leading up to menopause) and menopause: children who are adolescents or getting ready to leave the nest, caring for aging parents, pressures from work or career, changes in marital or partner relationships. These other stressors can make menopausal transition more challenging to deal with. (See the separate blog “Perimenopause: Is menopause here already?”).

Post-menopausal changes

Moving from perimenopause to a relatively stable post-menopause can be a lengthy process. Women frequently begin getting irregular periods up to six years before the last period, and the hormonal fluctuations that cause them can last for several years past the last period. It’s important to remember, however, that an average woman has menopause at the age of 51 and lives to the age of 79, which makes for about 28 post-menopausal years.

What are some of the changes women can expect by the time they reach post-menopause?

Hot flashes or flushes: Experienced by 75% of women during menopause, hot flashes are associated with reduced estrogen levels, which are thought to contribute to dilation of blood vessels and excessive perspiration, although the exact cause(s) and mechanisms are not well understood[iii]. Hot flashes can disturb sleep, or cause excessive overheating and sweating during the day. Worse, some women experience vertigo, light-headedness or heart palpitations along with their hot flashes. While not life-threatening, severe hot flashes can disrupt life significantly. The good news, however, is that hot flashes tend to be the worst during peri-menopause and the months immediately following menopause.

Vaginal dryness and painful sex: Due to lower estrogen levels, the lining of the vagina becomes drier and thinner, which can result in itching, burning, or occasional bleeding. Because the microflora in the vagina also alter at this time, some women can begin to get vaginal discharge. When these changes lead to painful intercourse, they can also cause distress for the woman’s male partner and, ultimately, relationship problems.

Weight gain and bloating: Like other symptoms, weight gain can also be also due to low estrogen, which results in excess fat storage in the belly area (visceral fat). It’s also thought that low estrogen levels impair the function of hormones that control appetite and the sensation of fullness, which further contributes to unwanted weight gain. Bloating results from excess gas or water retention, both of which can have different causes. High estrogen levels (usually associated with fluctuating hormones during perimenopause) cause water retention, whereas low estrogen (postmenopausal) can lead to excess gas.

Increased urinary incontinence: This problem results from loss of muscle tone, which occurs during menopausal transition and includes the muscles of the pelvis. Poor pelvic muscle tone can cause the organs located in the pelvic area, including the uterus and bladder, to “sink”.  At its most serious, the uterus or bladder can actually sink down far enough to protrude from the vagina, though this can also be contributed to by multiple pregnancies and vaginal deliveries.

Osteopenia or osteoporosis: These conditions, due to reduced estrogen and the resulting loss of bone density over time, are associated with menopausal transition, especially if they run in the female family line. Osteopenia is the precursor of osteoporosis, and those diagnosed with it are monitored carefully to watch for further deterioration. At its most severe, bone loss associated with osteoporosis can result in fractures, including the spine and hip which are serious injuries. (See separate blog on this condition “Osteoporosis: the bone loss disease”).

Cardiovascular disease: No established link has been found between menopausal transition and cardiovascular disease, however, there is some evidence that early menopause (at 45 years old or younger) can increase the risk[iv]. This is thought to be due to changes in blood vessel walls, making them more conducive to the formation of plaque and blood clots.

Insomnia: 40-50% of women experience sleep problems either in perimenopause or after the menopausal transition in the form of difficulty falling asleep or staying asleep, possibly influenced by reduced levels of melatonin and growth hormone, both of which affect sleep. Women who get nightsweats (hot flashes at night) are especially affected since these can further disrupt sleep. Of course, good sleep is foundational for optimal health so deficient sleep can have a major effect on overall quality of life.

Loss of memory and cognitive function: Many women report “brain fog” around the time of menopause, though it’s difficult to tease out the independent effect of the aging process itself.

Depression: 20% of women experience depression during menopausal transition, though this is more likely for women who are perimenopausal than those who have already passed through menopause[v]. Though the cause is unknown, it is thought that higher levels of testosterone may contribute to this. It goes without saying that persistent clinical depression can be life-altering.

Conventional (and not so conventional) medical treatment for post-menopausal symptoms

For many years, hormone replacement therapy (HRT) was the standard treatment for most menopause-related symptoms, especially common ones like hot flashes and vaginal dryness, with many women reporting significant relief. HRT comes in the form of a pill, patch, ring, gel, cream or spray. It was thought that HRT also contributed positively to reducing the risk of heart attack. However, more recent studies have shown that hormonal therapy actually increases the risk of heart attacks, breast cancer and stroke, as well as blood clots in the legs and lungs. Because of the risks, HRT is currently recommended only for short-term relief of menopausal symptoms [vi].

Due to the sheer number of women seeking some relief of symptoms resulting from perimenopause and menopause, there is huge demand for pharmaceutical, herbal and supplement products that claim to provide this. One is custom-compounded “bioidentical” hormonal therapy (cBHT) made from plant extracts and sold as dietary supplements. Available in cream or oral preparations, they are actually factory-made and called “bioidentical” since it is claimed they have exactly the same chemical and molecular structure as hormones that are produced in the human body. These products are enjoying rising popularity, but unfortunately they come with controversy and problems.

First, there can be risks associated with the process of custom-compounding that is not overseen by the FDA. Saliva testing used to individualize cBHT formulas is also not widely accepted, and there can be production problems related to contamination, quality control and the use of unknown additives.

Second, the medical community has for more than ten years repeatedly asserted that there is a lack of evidence to support the safety or efficacy of BHT. As recently as July of 2020 a review of the existing evidence by the National Academies of Science, Engineering and Medicine went further and concluded that wide-spread use of cBHT “poses a public health concern”[vii].

Serious urinary incontinence problems resulting from organ prolapse can be resolved with bladder lift surgery. Less serious urinary incontinence can be treated with hormonal creams, antispasmodic drugs as well as a device called a “pessary”, which is inserted into the vagina and prevents urinary leakage.

Osteopenia and osteoporosis can be treated with hormonal therapy, however, the main approach is a class of drugs called biophosphonates, usually taken orally; or monoclonal antibody medications that are given by means of a shot every 6 months. (See the blog “Osteoporosis: the bone loss disease”).

Insomnia associated with menopausal transition is also treated with hormonal therapy, along with other drugs. As well, cognitive behavioral therapy is growing in importance as a viable non-drug approach to treating insomnia.

Other than hormone therapy, which is not typically recommended for menopause-related loss of memory and cognitive function, there are no specific drugs. Some doctors suggest increasing physical exercise, which has been shown to generally improve brain function in older adults.

Depression associated with menopause is treated in the same way as for other populations. Typical drugs of choice that are prescribed for menopausal women are the selective serotonin reuptake inhibitors (SSRIs).

A natural approach to menopause

With the recommendation to use HRT for only short periods, and troubling concerns about cBRT, women with disruptive symptoms like hot flashes and vaginal dryness have limited options. A natural approach like homeopathic remedies, which are federally recognized in the US, can therefore be very helpful.

One advantage of homeopathic care is that the remedies work with the body’s own ability to heal itself. This means that, unlike prescription drugs or supplements, they are taken until resolution is reached, not for the rest of your life.

We will first have a long conversation that includes a detailed analysis of all your symptoms: emotional, cognitive and physical; some may be common, others may not.

First are the things you can do on your own:

If you are a smoker, menopausal symptoms are yet another reason to think about reducing or quitting altogether.

If you have not yet established a regular exercise routine, then start now! It doesn’t have to be fancy, expensive or exhausting, and it definitely should not be painful: walking is just fine! Among its many benefits, weight-bearing exercise like walking can significantly reduce progression of osteoporosis.

If you have put on unwanted weight, please call or Email and ask me about how homeopathic care can help contribute to weight loss and long-term weight management.

Finally, I have self-care handouts that address a number of different menopause-related symptoms which include nutrition, exercise and lifestyle suggestions you can implement on your own.

Most symptoms associated with the menopausal transition can be addressed using various homeopathic remedies. Some of these medicines are chosen because they target specific body systems or organs, such as the endocrine (or hormonal) system, cardiovascular system, urinary system and bladder, digestive system or the bones. We would probably start with the symptoms that are of greatest concern to you, working through them until you are feeling more comfortable in your skin.

Our overall aim would be to enhance what can be an exciting and highly rewarding part of a woman’s life-cycle.

“The silvered glamour of the Woman of the Winter Moon may be woman in her greatest power, woman in her guise as Elemental, as Force of Nature. This is woman to be revered”. - - Elizabeth S. Eiler, Singing Woman: Voices of the Sacred Feminine

[i] I am indebted to Karen Allen LHP, homeopath extraordinaire and teacher of all things hormonal, who always provides a balanced, pragmatic and compassionate perspective to every subject she addresses.

[ii] Examples are: Christiane Northrup (2012) The Wisdom of Menopause; Marianne Williamson (2008) Age of Miracles; and Susan Love (2003) Menopause and Hormone Book

[iii] Freedman, R (2014) “Menopausal hot flashes: mechanisms, endocrinology, treatment” Journal of Steroid Biochemical Molecular Biology (142): 115-120.

[iv] Wellons, M, P Ouyang, P Schreiner, D Herrington, D Vaidya (2012) “Early menopause predicts future coronary heart disease and stroke: the multi-ethnic study of atherosclerosis” Menopause 19(10): 1081-1087

[v] Freeman E, M Sammel, L Liu, C Gracia, D Nelson, L Hollander (2004) “Hormones and menopausal status as predictors of depression in women in transition to menopause” Archives of General Psychiatry 61(1):62-70https://pubmed.ncbi.nlm.nih.gov/14706945/

[vi] Zhang, G-Q, J-L Chen Y Luo M Mathur P Anagostis U Nurmatov M Talibov J Zhang C Hawrylowicz MA Lumsden H Critchley A Sheikh B Lundback C Lasser H Kankaanranta SH Lew B Nwaru (2021) “Menopausal hormone therapy and women’s health” PLOS https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003731

[vii] National Academies of Sciences, Engineering, and Medicine (2020) The Clinical Utility of Compounded Bioidentical Hormone Therapy: A Review of Safety, Effectiveness, and Use. Washington, DC: The National Academies Press: https://doi.org/10.17226/25791