Managing menopause symptoms

Managing the symptoms of menopause

Menopause occurs in most women between the ages of 45 and 55 years. For some it causes few problems, but for others it can make life extremely miserable. Interestingly in Asian countries where there is a high intake of soy and other phyto-oestrogens, menopause is rarely a problem.  These people mainly eat fermented soy which may be different and healthier than most soy products on our shelves. 
At menopause the normal female hormone cycles (oestrogens and progesterone) shut down, and particularly the lack of oestrogens cause symptoms of hot flushing, sleeplessness, palpitations and others.
Why do they happen?
The hot flushes (flashes in American English) are probably due to the lack of oestrogen. This affects the thermoregulatory nerves in the hypothalamus which keep our temperature within a very narrow range. The sudden absence of oestrogen makes the hypothalamus much more sensitive, and instead of waiting until the core temperature rises 0.4°C above normal, the hypothalamus starts to dissipate heat from the body at a much lower temperature. This starts with a hot flushing feeling in the chest and face which spreads around the body – due to dilation of the small arteries – to try and lose heat. This is then followed by sweating and frequently palpitations. Sometimes these are followed by chills and shivering as the body temperature has been lowered. When this happens at night it frequently disturbs sleep.
What can we do about it?
Stop the body temperature from rising particularly suddenly, keep the room temperature low use fans etc, wear clothes in layers which can be removed easily.
Avoid triggers such as spicy food, stressful situations, caffeine, alcohol, cigarette smoke, tight clothes and possibly sugar (especially sweet food at night).

Complimentary (natural) treatments –

• Soy and soy products, also grains, brown rice, tofu, nuts contain a variety of compounds which can help.
• Isoflavones and phytooestrogens (plant oestrogens) – such as soya beans, chick peas, lentils, flaxseed, grains – these act as mild oestrogens.
• Black cohosh has been shown to be helpful. Some have suggested evening Primrose although there was no evidence for its efficacy.
• Acupuncture, mindbody medicine including stress management, relaxation, deep breathing techniques and guided imagery.
• Gentle weight loss can be helpful for those who are overweight.
• Exercise – Gentle exercise may possibly be beneficial, although there have been no trials confirming this. Hard exercise, by raising the core temperature can often make the hot flushes worse.
• Probiotics – good gut bacteria can help the metabolism and utilisation of oestrogens, and probiotics can maintain these good bacteria.
• Supplements – vitamin E (400 800 mg a day), calcium and magnesium (500 to 750 mg daily), vitamin C (1 to 2 g daily) may also help.
• Dong Quai 500 -1,000 mg three times daily may possibly help. Some people feel that ginseng helps, but there is no evidence for this.

Drug therapy – if the flushes are severe and affecting the quality of life, (especially sleep) then drug therapy can help. Until the results of The Women's Health Initiative Trial came out, it was routine for women to take HRT as they reached the menopause. This trial however showed that women taking HRT (synthetic oestrogens and progestogens) had a higher incidence of breast cancer. Thus HRT is no longer recommended. Whether this applies to 'natural' progesterone and oestrogens we do not know.   There is still some debate on the WHI trial with different age groups and for those who have had a hysterectomy.   For younger women (under 65) and those without a womb, maybe oestrogen is good. 

• Bio identical oestrogens and progesterone. These are made by compounding pharmacies or obtained from an Integrative health practitioner and are usually applied as an oil or cream onto the skin. (The hormone thus does not need to pass through the liver before entering the circulation. Any hormone taken by mouth has to pass through the liver, which metabolises it. This is why drug companies have created synthetic oestrogens and progestogens which are not affected by the liver, but this means they are not the same as natural hormones.) There are three forms of oestrogen – E1 (oestrone), E2 (oestradiol), E3 (Oestriol) – with E1 and E2 possibly being the ones with greatest risk. Thus bio identical oestrogen creams and oils contain all three (tri-oestrogen) with the most common combination of 10%, 10% and 80% of E1, E2 and E3.
• Natural progesterone creams and oils can also help with some of the menopause symptoms. It should always be used with oestrogens, as there is an increased risk of uterine cancer with oestrogen alone.
• Synthetic oestrogen preparations – these are usually given on prescription and can be tablets, transdermal patches, tropical gels and lotions, vaginal cream and tablets. Women who have their uterus must always be put on progesterone as oestrogen alone can increase the risk of uterine cancer.
• Antidepressants – the SSRI antidepressants such as paroxetine or citalopram are very effective in reducing the symptoms.
• Gabapentin – this drug which is usually used for treating pain or epilepsy can also effectively reduced the symptoms presumably by its action on the hypothalamus, and is especially useful when given at night (300 mg) to reduce the sleep problems caused by hot flushing.

It is best to try the more natural therapies first, especially diet and lifestyle changes. The symptoms usually become less after a year or two, and once controlled it is best to gradually reduce any medication therapy after 12-24 months.