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The natural treatment of menopause By Deborah Gordon F or most women in our culture, the years surrounding menopause present a variety of challenges. Our bodies, our lives, our families, our roles, and our expectations may all be changing. There has been a lot of media attention to menopause and the benefits of hormone replacement therapy. However, many women still feel uncomfortable about taking hormones, usually out of a fear of breast cancer. I practice as a homeopathic physician and will describe my own approach to working with women seeking natural treatment, as well as some of the other options available. The treatment of menopause is a big subject, very complicated, constantly changing and controversial as well, so I will try to be organized and specific! I consider there to be two forms of natural treatment of menopause: Holistic: Treatment and self care directed at the whole woman, including her menopausal state, but not limited to it; and, Symptom Based: In this approach, one may use prescribed medications, herbs, vitamins, homeopathic remedies, acupuncture, even exercise, etc. Treatments are selected to reverse or prevent specific health problems or concerns. Holistic Approach A holistic approach is the key to Natural treatment of menopause. A holistic approach is based on the understanding that the most important step toward a healthy menopause is ensuring that the individual woman is as healthy as possible. Classical Homeopathy, Acupuncture, Ayurvedic Medicine, and others, have different ways of offering a holistic boost to a woman’s health. I always recommend that a woman start with a holistic approach, which often involves consulting a physician. Holistic Treatment: In my practice, the holistic approach consists of an evaluation for a prescription of a "constitutional" (whole person) homeopathic remedy. The patient comes for a lengthy interview (I see new patients for two hours) during which she talks about her health concerns, past, present, and future, as well as who she is as a person. The interview is the basis for the selection of the remedy, which, if properly selected, will help her be as healthy as she can be. Quite unlike conventional medicine, the homeopathic remedy is selected on the basis of Like Cures Like. Like Cures Like: A remedy will help when a person has the same symptoms that would be caused if that remedy were given to a healthy person. A remedy is chosen to match the whole person, including all their health concerns. I consider also personal idiosyncrasies ("what is your favorite food?" ; "I have really hot feet!") that are not symptoms to be cured, but characteristics that help define the person. There are over 2000 homeopathic remedies, so each case is a new mystery to solve, a search to find the correct remedy. Two examples will show how treatment is individualized. Imagine that two women are complaining primarily of sleeplessness due to hot flashes. In each interview I learn a great deal about each woman. The first woman wakes with a suffocating sense of heat, has to uncover and loosen her pajamas. She has heart palpitations if she lies on her left side. On a personal level, she admits that she has become more jealous in menopause. I would give this woman the remedy Lachesis . If the remedy is correct (if it matches the full picture described in the interview), her symptoms will reduce sufficiently to allow sleep. Additionally, her health in general will improve, so any tendency to sore throats, asthma, etc., will also improve. The second woman also wakes from sleep, but she notices that her feet become quite hot, she has heartburn, and sometimes her whole digestion is upset. On a personal level, she notes that she has gone through "menu-pause" and is sick of doing housework! I would give this woman homeopathic Sulphur based on her symptoms, and again hope to see an improvement in her overall health, including her particular complaints of menopause. The correct remedy will improve a woman’s health sufficiently that her menopause continues smoothly, OR, at least, it will improve her health enough so that remaining symptoms are easy to manage with life-style measures or simple natural treatments. Holistic Self Care: Life-style modifications comprise an essential part of a natural treatment program. Many different aspects of a woman’s life can enhance her well-being at menopause. Making healthy choices about diet, exercise, stress, and sleep can be important first steps before any isolated treatment is likely to work well. Our behavior does NOT have to become perfect in menopause, but at least we can make conscious choices. I start with advice that might be generalized for aging, including nutrition and vitamins in general, other anti-oxidants, exercise, stress management, and sleep: probably our most important health tonic! Other important considerations are social connections, personal relationships and social involvement, which can boost a sense of well-being. I also add a cautionary note about hidden sources of hormones and how to avoid them: In dairy and meat products, I encourage women to buy organic products, especially for products with animal fat, such as butter. Organic poultry is easily obtained and free of many types of chemicals. Look for organic sources of those foods that contain the highest levels of pesticides: strawberries, bell peppers, spinach, cherries, peaches, celery, apples, apricots, green beans, cucumbers and grapes or cantaloupes from out of the country. The System Based Approach This approach pinpoints treatments for specific problems. I recommend here that a woman take at least a half-hour appointment with me to discuss her concerns, complaints, hopes and questions about menopause. I am specifically interested in the age of menopause, her general health history and status at menopause, her family history and any particular concerns or symptoms associated with menopause. Question: When do you consider natural hormone therapy? When a woman has reasons for which she might want to take hormone replacement therapy (such as osteoporosis, family history of heart disease or colon cancer), but stronger reasons that she doesn’t want to take them (such as history of breast cancer or just personal choice!), we start working through the options of natural treatments for her problems, either Natural Hormones or Natural Alternatives to Hormones. Natural Hormones "Natural" can be a misleading word in this discussion. For instance, Premarin is a commonly prescribed estrogen which comes from a very natural source: the urine of pregnant horses. However, when I use the word "natural", I mean hormones that are the same as the hormones a woman makes in her own body. Natural estrogen is available in several forms: most commonly, Estradiol alone (the most potent of natural estrogens) or Bi-est or Tri-est (which combines the several natural estrogens, in varying ratios). Natural progesterone is available as micronized progesterone. These natural hormones are available by prescription only, and can be found at many local pharmacies. Progesterone is available without prescription in topical preparations, such as PRO-GEST, and can be used particularly to ease menstrual irregularities, hot flashes, and mood changes. Dosages are small: 1/4 tsp applied to skin twice daily, and safe when used as directed. Natural alternatives to hormones include plant based estrogens (phytoestrogens in foods and herbs) and progesterones as well as other herbs, vitamins, and supplements. Phytoestrogens play a dual role that is being seriously studied. They seem to offer the beneficial effects of estrogen in a weaker form that blocks the harmful effects of the stronger estrogens. All of the natural alternatives mentioned here, when taken in moderation, are usually safe for a woman to take on her own. A woman with significant health risks or any unwanted effects from taking these substances should consult a health care practitioner. Herbs are usually available as tincture, powder, pills or the fresh herb, in local health food stores. Women unfamiliar with herbs should choose a tincture or pills where the standard dosage is listed on the bottle. Herbal Sources of Hormones Include: Red Clover - a phytoestrogen source discovered when clover munching sheep were unable to become pregnant! Dong quai is a warming herb, and is mildly estrogenic Black cohosh is standardized in various pills, also available as an herb, Ginseng (Oriental and Siberian) is actually an adaptogen: it helps stimulate weakness and moderate excess, so it helps at any time, and Chasteberry, or vitex agnus-castus acts to stimulate progesterone production, so it is useful in PMS-type complaints or in peri-menopause. Phytoestrogens and indeed much of the story of menopause is a story still unfolding, with conflicting evidence along the way. Working with a knowledgeable practitioner can help you apply what is best understood with your individual health concerns. Vitamins can contribute to menopausal well being. Important are: Vitamin A and related beta carotenes help slow physical changes, stimulate the immune system and act as an anti-oxidant (5-10,000 I.U. daily) Vitamin C may help prevent hot flashes when coupled with Vitamin E and is also an anti-oxidant (1-5,000 mg. daily) Vitamin D (400-1200 I.U.), Calcium (1000-1500 mg) and Magnesium (250-750 mg) taken daily can help prevent and with exercise even reverse osteoporosis Vitamin E has been shown to reduce hot flashes and anxiety; also an anti-oxidant (400-1600 I.U. daily) Nutrients can be very helpful during menopause and are usually milder in their effects. Bioflavonoids, from many fruits, can help with hot flashes and mood changes. Many foods contain phytoestrogens, as mentioned above. Valuable foods in a healthy menopause diet include: Grains, particularly whole grains such as whole wheat, brown rice, oats, barley, rye and cornmeal; Vegetables, including cucumbers, radishes, carrots, cabbage, etc.; Fruit such as pomegranates, cherries, rhubarb, apples, citrus; Seeds: both flax seeds (freshly ground) and sesame seeds can play a role in hormone balancing; ...and many more foods, NOT including the commonly consumed yam. The widely described wild yam is used in synthesizing progesterone, but is not edible as a yam and bears no resemblance to our yams and sweet potatoes. Balancing the essential fatty acids is another important part of hormonal balance, which usually means increasing the intake of omega-3 essential fatty acids, which are plentiful in walnuts, flaxseed, flaxseed oil and the cold water fish such as salmon and tuna. I would like to close with a word of encouragement to women approaching this subject and this time of life. Menopause, like many health challenges, offers women a tremendous opportunity: there are many options, both pharmaceutical and natural, and the choice is yours! Information is widely available, and often conflicting, so it is important to find a way of sorting through this information that is worthwhile in and of itself. Working with a trusted health-care practitioner or information source can provide support for many health enhancing choices at this time of life and offer the basis for a long-term path to improved health. May every woman greet menopause by taking a holistic step towards a healthier future for herself. Deborah Gordon, M.D., is a Family Practitioner specializing in Classical Homeopathy, who has been practicing in Ashland for ten years. She teaches at the esteemed Hahnemann College of Homeopathy, and has taught and written in numerous locations, including an upcoming medical textbook on Homeopathy. She is series editor and co-author of the "Women’s Natural Health Series", including Menopause, the Natural Way, published by John Wiley & Sons, 2001. Deborah Gordon, MD, is a family practitioner specializing in classical homeopathy. She has had her practice in Ashland for ten years.