Introduction:

As one of the three million baby boomer women who will experience menopause in the 1990's, at forty-five years of age I started experiencing the most common symptoms of menopause: hot flashes, night sweats, and changes in my menstrual cycle. At this time, I became concerned about the treatment options that were available to me. In my own experience, I have found alternative therapies are my own choice, and what have been beneficial to me up to this time. I also feel that what has worked for me may work for other women. However, whatever choice is made, it needs to be made by the woman herself and not for her.

Rejecting traditional treatment for menopause, led me on the path of deeper investigation on my own to find out what would work best to alleviate the symptoms and discomforts I was experiencing. I am reluctant to take estrogen replacement therapy because I have fibroid tumors in my uterus. One of the side effects of estrogen is that it ncreases the size of uterine fibroids. However, as a woman reaches menopause estrogen diminishes and therefore, fibroid tumors decrease in size. I felt that I wanted a gentler and less harsh approach to my menopausal symptoms. I had to find a physician who is a chiropractor/ homeopath who is knowledgeable regarding menopausal symptoms and how to treat them with herbs, vitamins, diet, soy products and exercise. Experiencing menopausal symptoms and reading about alternative therapies led me to do an in-depth research paper on alternative medicine and menopause.

Purpose:

The purpose of this paper is to educate women about what menopause is and it's symptoms and treatments, along with an explanation of the traditional treatment, hormone therapy. I will also focus on the alternative therapies to traditional ones, and in doing so, inform women about both menopause and the treatment options, so that they can make an informed choice.

I will also focus on the importance of knowing what menopause is, so as to "demystify" it. I feel that the more a woman knows about what is happening to her body, the less fearful she may be. Also, through education about menopause and our bodies, this will empower us to take charge of our health and allow us to feel less helpless and powerless as we go through this most important transition phase of our lives. It will help us to not totally depend upon the mainstream medical community to make decisions for us, as to how we treat the symptoms of menopause.

To begin, I would like to define some most frequently used terms of menopause and most common symptoms that women experience before, during, and after menopause.

Definitions:

1. Menopause: Permanent cessation of menstruation due to loss of estrogen. Clinically, menopause is diagnosed after 12 months of having no periods. The average age is about 51 years.

2. Perimenopause: The time before menstruation stops. A woman may have classic symptoms at this time, such as night sweats, hot flashes, and irregular menstrual cycles.

3. Hormone replacement therapy (HRT): Administration of hormones for the replacement of hormones no longer being produced by the body. HRT usually refers to a combination of the drug estrogen and a progestin.

4. Hormone: A chemical substance circulating in the body fluids that is a product of living cells and that produces a specific effect on the activity of cells remote from its point of origin.

5. Estrogen: A class of hormones important in promoting female characteristics.

6. Estrogen replacement therapy (ERT): The most common form of prescription estrogen therapy that uses estrogen alone without progestins.

6. Progestin: A synthetic form of progesterone.

7. Progesterone: A natural ovarian hormone made by the corpus luteum (the yellowish mass that develops in the ovary following ovulation), to sustain the endometrium (lining of the uterus), and support the fertilized ovum.

8. Postmenopause: The years after the cessation of menstruation.

9. Endocrine: The hormone-secreting glands.

10. Fibroid tumors: Benign (non-cancerous) tumor of fibrous tissue found in the uterus.

11. Premarin: Estrogen replacement drug derived from pregnant mare urine (horse urine).

12. Provera: A synthetic progestin commonly used in combination with Premarin.

Common menopausal symptoms:

1. Hot flashes: Sensation of warmth frequently accompanied by skin flushing and perspiration. A chill may follow as core body temperature drops. May last a few seconds to an hour and can be occasional or frequent.

2. Night sweats; Hot flashes that occur during sleep.

3. Urinary incontinence: Frequency, urgency, and inability to hold urine.

4. Vaginal dryness: Itching, painful intercourse, and irritation.

5. Mood swings: Feelings of happiness alternating with feelings of sadness.

6. Dry skin: Flaking or cracking of the skin.

7. Irregular menstrual cycles: Periods that come close together, skipped periods, long intervals between periods, and longer or shorter duration of menstrual flow.

8. Migraine headaches: Headaches due to fluctuations in hormonal balance.

9. Depression: Feeling sad or low.

10. Insomnia: Inability to fall asleep or awakening in the middle of the night.

11. Decreased libido: Loss of sexual desire.

Terms used in alternative medicine:

1. Phytoestrogen: A compound structurally similar to human estrogen that is found in plants. It can bind with estrogen receptors in the body and is believed to be protective in breast cancer, which is a hormone-dependent cancer.

2. Phytonutrients: A nutrient coming from plants.

3. Isoflavones: Compounds found in plant foods such as soy that resemble estrogens produced in the body and that are mildly estrogenic.

4. Soy products: Foods derived from soybeans, for example; tofu, soy mild, tempeh, miso, and protein powders.

5. Herbs: Botanicals derived from plants. (Greendale, Gail A., Lee, Nancy P., Arriola, Edgar R., "The menopause. (Seminar)," The Journal of the Lancet, v. 53, n. 152, 1999, pp. 71-85, Laux, Marcus N.D., Conrad, Christine, Natural Woman, Natural Menopause, New, York, N.Y., HarperPerennial, 1997).

The main treatment option given to women by their doctors who experience symptoms of menopause, has traditionally been estrogen replacement therapy (ERT) in the form of Premarin, hormone replacement therapy(HRT), a combination of Premarin and Provera, a synthetic progesterone, or birth control pills.

With the high incidence of HRT and ERT being recommended to women, I feel it is imperative that women realize what is being prescribed to them and the side effects. During my research, I found a common complaint by women that they were given prescriptions for ERT and HRT with no education or discussion as to their side effects or other treatment options. The side effects of Premarin include: vaginal bleeding, breast tenderness, bloating, water retention, headaches, growth of fibroid tumors in the uterus, and possible risk of breast and uterine cancer (Kaplan, Deborah, "Phytoestrogens: Fact and fiction. (soy-based protein"), Journal of Patient Care, v. 33, n. 6, 1999, pp. 127). Provera is a synthetic progesterone that is often prescribed along with Premarrin. The side effects that occur in 10 to 40% of women are: bloating, irritability, mood swings and breast tenderness ("More targeted products define new options," Menopause News, v. 9, n 2, 1999, pp. 1). The best way to make an informed decision regarding what therapy a woman will choose, is with knowledge of what is being offered to us,

While doing this research, I discovered numerous recurring themes in relationship to the treatment women receive during this important transition of their lives. One major theme surrounds my decision and other women's decision to view menopause as a transition and a time of renewal and changing lifestyle habits to ones that are more healthy for us. I also view this transition as a time to nurture and take care of ourselves and take time to listen to our bodies. This is a time not to be afraid that our bodies are betraying us, but a time to listen, learn, and ask questions and embrace what is happening to us. I admit there are times when periods skip a month, come too soon, too late, and last too long. However, I have learned that this is a part of menopause. Also, when hot flashes and night sweats occur, there can be feelings that our bodies are out of control, but, through understanding and learning coping skills, we can look at these changes in a different light, even though we feel uncomfortable and ill at ease.

The first book I read on this subject was Natural Woman, Natural Menopause by Marcus Laux, N.D., (naturopathic physician), and Christine Conrad. Their book builds everything else around the issue of menopause as a natural transition. The authors advise diet, exercise, vitamin supplements, natural progesterone cream and lifestyle changes. These recommendations are not only for the treatment of menopausal symptoms, but in their view, a way of life for long-lasting health. This was encouraging to me and also empowering, because they do not approach menopause from a narrow perspective, but from a perspective that these changes can positively affect the rest of women's lives and includes the whole person. An added bonus to this reading is the co-author, Christine Conrad, who is a patient of Dr. Laux's. She gives her perspective as a patient and describes an excellent model of doctor-patient relationship, especially one of mutual cooperation and respect.

Research on the topic of menopause and alternative medicine revealed many reasons why this is such a sought after therapy by women in the 1990's. Women have many concerns regarding the use of ERT/HRT; mainly side effects, risk factors for cancer, and concerns about long-term use (5 to 10 years or more) that is usually recommended. There is concern among younger women, like myself, at the age of forty-five who are perimenopausal, and the early start of traditional treatment that may last even longer. For this reason, other options to traditional treatment have been viewed by women as a welcome change in light of the longevity of women and its implications for using alternatives ("Change' for the better and ease into menopause with Black cohosh," Victoria Dolby, Better Nutrition, 1996, pp. 30).

Healthcare professionals are not totally embracing alternative therapies; however, they are expressing concern over the high dropout rates and low compliance of women who start hormonal therapy ("Beyond hormones: Other treatments for menopausal symptoms," Marcia Ringel, Journal of Patient Care, v. 32, n. 8, 1998, pp. 28). There is also growing awareness among doctors that their patients are using alternatives such as the herb, black cohosh and soy protein products, with or without their consent. There is an awareness that women have a desire to take control of their own health and play a role in the decision-making process with their doctors, and alternatives are a large part of this ("Phytoestrogens: Fact and fiction. (Soy-based protein), Deborah Kaplan, Journal of Patient Care, v. 33, n. 6, 1999, pp. 121). In the article, "41 ways to cope with menopause naturally," by Dianne Molvig, allopathic and naturopathic physicians discuss the importance of women making choices that work best for them and emphasize that no choice has to be permanent (Natural Health, 1995, pp. 88).

With this background, the next section will discuss alternative therapies that I have found beneficial for me with references to research literature.

The herb Cimicifuga racemosa, also known as Black cohosh, has been used for centuries by Native-American women to treat uterine disorders and female complaints by promoting or restoring healthy menstrual activity, soothing irritation and congestion of the uterus, cervix and vagina. Since the early 1940's, Germany has used black cohosh as a natural hormone to treat symptoms of menopause such as hot flashes, night sweats and mood changes. Black cohosh is said to have hormone-like effects in women who have menopausal symptoms. The safety of black cohosh has been verified by clinical trials and studies done in Germany. The German government's Commission E, comparable to the United States Food and Drug Administration (FDA), which regulates the safety and efficacy of herbal products, has approved the use of black cohosh for menopausal symptoms. The Commission reports that the herb has been used for over 40 years with no serious side effects. There has also been no dropout rates among women who use black cohosh. It's safety is due to being a phyto (plant) hormone; therefore, women who are sensitive to hormones can use it safely. Due to its safety and efficacy, black cohosh can be used on a long-term basis without concern of long-term adverse effects (" A review of the effectiveness of Cimicifuga racemosa (Black Cohosh) for the symptoms of menopause," Shari Lieberman, Ph.D., C.N.S., Journal of Women's Health, v. 7, n. 5, 1998, pp. 526-29).

Foods rich in soybeans such as tofu, soy milk, tempeh, soy yogurt, miso, soy cheese, soy protein powder and numerous other soy products have been the staple of Japanese women's diet. In Japan, it is related that their is no word for "hot flash" due to their soy rich diet (Natural Woman, Natural Menopause, Laux, Conrad, 1997). Soy-based protein is being recognized as an important part of a woman's diet before, during and after menopause. I have found it to be not only beneficial for menopausal symptoms, but also a healthy way to eat. These products are usually low in fat, cholesterol, calories and preservatives. Deborah Kaplan with contributors, Lisa A King and Bruce Carr, M.D., report that soy-based proteins may become acceptable alternatives to HRT in the future. The authors recognize that the most popular current alternative to traditional HRT is soy-based proteins ("Phytoestrogens: Fact and fiction. (Soy-based protein), Journal of Patient Care, v. 33, n. 6, 1999, pp. 127).

Lecithin is a soy-based vitamin supplement that was recommended to me by my homeopathic physician for hot flashes and night sweats. Although I found no research on lecithin, I feel it has helped alleviate my symptoms.

Vitamin E has shown to significantly alleviate hot flashes, night sweats and other menopausal symptoms. Dr. Laux recommends that vitamin E be taken along with a multivitamin supplement in order to have true benefits (Natural Woman, Natural Menopause, 1997).

Diet and exercise have been a very important part of my own self-care in order to help alleviate symptoms and gain better heath. It is recommended that our diets be rich in fruits and vegetables, whole grains, legumes (bean, peas), and soy-based products. The elimination of or moderate us of caffeine, diet soda and soft drinks has been advised. Carbonated beverages have shown to leech calcium from the bones.

Exercise is extremely important, especially cardiovascular such as brisk walking, running or aerobic exercise. Cardiovascular exercise helps relieve stress, builds our cardiac strength and strengthens bones and joints, and helps alleviate hot flashes. Weight bearing exercises are important for our bone strengthening and bone density. Stretching is relaxing, helping keep our muscles and joints flexible as we age (Natural Woman, Natural Menopause, Laux, Conrad, 1997).

Progesterone is an important complement to estrogen therapy. It is believed by some doctors, such as Dr. Laux and others, that the use of progesterone is important for women along with estrogen in order to protect the endometrium, lining of the uterus. Dr. Laux feels that this has been overlooked and that more progesterone than estrogen may be needed to help balance hormones in a menopausal woman. When progesterone is used in traditional therapy, the synthetic, Provera, is often used. It is believed that transdermal progesterone creams that naturally match the hormone produced in the ovaries are most beneficial. Natural progesterone creams are derived from plant sources, vitamin E, and herbs, and have no side effects with their use. I have found that Pro-Gest*, a natural progesterone cream, has not only been beneficial in the symptoms of menopause, but also in alleviating the symptoms of premenstrual syndrome (PMS). There have been clinical studies to verify the effectiveness of transdermal progesterone cream which have found them to be absorbed in the bloodstream and, therefore, effective in alleviating symptoms ( Natural Woman, Natural Menopause, Laux, and Conrad, 1997), ("Percutaneous absorption of progesterone in postmenopausal women treated with estrogen," Kenneth A. Burry, M.D., Phillip E. Patton, M.D., and Kent Hermsmeyer, Ph.D, American Journal of Obstetrics and Gynecology, v. 180, 1999, pp. 1504-11).

Practical coping strategies for hot flashes:

1. Women should identify foods that trigger hot flashes, for example: spicy foods, hot beverages, caffeine, tyramine in aged cheese, red wine and tomatoes.

2. Frequent sips of ice cold water or sucking on ice cubes.

3. Keep your rooms cool, especially the bedroom. A cool bath or shower may help suppress hot flashes.

4. Wear comfortable, loose fitting clothing made of natural fibers such as 100% cotton, silk and linen.

5. Sleep in all cotton night wear, preferably white, and sleep on all cotton sheets to help night sweats.

6. Dress in layers.

7. Take a small fan to work.

8. Read all you can! ("Beyond hormones: Other treatments for menopausal symptoms. includes articles on solutions to symptoms," Marcia Ringel, Journal of Patient Care, v. 32, n. 8, 1998, pp. 28-42).

With all of this information just given, it may seem overwhelming; however, it is important to take this information in stages. Maybe, focus on just one aspect of alternative therapies, such as starting a good multivitamin or making gradual changes in your diet, finding a comprehensive book on menopause in order to begin understanding the transition, if you decide to try alternative therapies. Also, I recommend when at all possible, to seek out a qualified healthcare professional who will be willing to listen and learn and work with you. Be sure she/he is knowledgeable about menopause and alternative treatments. Be sure to establish a complementary relationship with your healthcare provider. Remember, as we take these steps toward enhanced health and well-being, we are taking steps to empower and benefit our overall health for a lifetime, not just solely for the purpose of getting through menopause.

From a feminist perspective, I believe that the way menopause is portrayed and treated, is from the "fear-based" perspective by the mainstream medical community. Due to this "fear-based" perspective, women believe that there is only one way to approach treatment of menopause, i.e., ERT/HRT. I made a conscious decision to learn all that I can about menopause and its symptoms by reading books, articles, talking with knowledgeable people in the natural healthcare industry, and attending an excellent lecture. Two authors have also approached menopause from the feminist perspective. One author, Susan Love, M.D., "argues that defining menopause a an "estrogen deficiency disease" "medicalizes" the normal aging process and ensures that an entire population of healthy women will be treated as patients"("Menopause, gynecologists, drug companies and the push to put every woman on hormones", Journal of Health Facts, v. 27, n. 214, 1997, pp. 5). Rosemary Whittaker examines how women are portrayed in medical journal advertisements for HRT. She sees these ads as sexist and patriarchal. Ms. Whittaker explains that by advertising women who reach midlife as old and unhealthy looking, effects how pharmaceutical companies and doctors view and treat women. ("Re-framing the representation of women in advertisements for HRT," Whittaker, Journal of Nursing Inquiry, 1998). These two perspectives give more meaning to the issue of HRT than just treating symptoms that a woman experiences at midlife, but also how women are viewed as a whole. I attended an excellent lecture on "Natural Hormone Replacement," given by Catherine M. Wood, MSW, CADC, a licensed social worker and trained herbalist on September 21, 1999. The lecture included educational information about herbs and their benefits for treating menopausal symptoms. During her lecture, she commented that since menopause is a "woman's issue", the mainstream medical community and the FDA does not want to spend time and money on finding and researching natural alternatives to ERT/HRT.

In summary, the symptoms and changes that menopause causes in women's bodies do not have to be faced with fear and the feeling of loss of control. I feel that with sufficient education, background, and awareness of our bodies and what is occurring within us, menopause can be looked upon with strength and courage. I admit I do not always understand what is happening or feel comfortable with the changes , but I have chosen to take each day at a time and each change as it occurs. I believe that in doing so, I am able to continue to take charge of my own body and make educated decisions about what choices I decide to make in relation to my treatment options. I would like to emphasize again, that whether a woman chooses ERT/HRT treatment or alternative therapies, the decision should be hers.

In Conclusion, since I started research on this topic, with the growing use of herbs and vitamin supplements mostly by women, the National Institutes of Health has awarded the University of Illinois at Chicago a $7.9 million grant to study dietary supplements' effectiveness. The first study will be on the use of botanicals (plant substances) for the treatment of menopausal symptoms. The researchers point to the demand among women for botanicals to treat menopausal symptoms, the risks associated with ERT, and potential benefits of alternatives to ERT, as motivating factors to start the study with women's health issues. This clinical trial with government backing further illustrates the point that women's decision to choose alternative therapies is making an impact on mainstream medicine.
 
 
 
 
 
 
 

References:

1. Laux, Marcus, N.D., Conrad Christine, Natural Woman, Natural Menopause, , New York, New York, HarperPerennial, A Division of HarperCollins Publishers, 1997.

2. Greendale, Gail A.; Lee, Nancy, P.; Arriola, Edgar R., "The menopause. (Seminar)," Journal of the Lancet, v. 53, n. 152, 1999, pp. 71-95.

3. Love, Susan, M.D., "Menopause, gynecologists, drug companies and the push to put every woman on hormones," Journal of Health Facts, v. 22, n. 214, 1997, pp. 5-7.

4. Molvig, Dianne, "41 ways to cope with menopause naturally," Natural Health, v. 25, n. 3, 1995, pp. 88-94.

5. Dolby, Victoria, "'Change' for the better and ease into menopause with black cohosh, Better Nutrition, 1996, pp. 30-32.

6. "More targeted products define new options," Menopause News, v. 9, n. 2, 1999, pp. 1-6.

7. Lieberman, Shari, Ph.D., C.N.S., "A review of the effectiveness of Cimicifuga racemosa (Black cohosh) for the symptoms of menopause," Journal of Women's Health, v. 7, n. 8, 1998, pp. 525-29.

8. Kaplan, Deborah, "Phytoestrogens: Fact and fiction. (Soy-based protein)," Journal of Patient Care, v. 33, n. 6, 1999, pp. 127-37

9. Ringel, Marcia, "Beyond hormones: other treatments for menopausal symptoms. (includes related articles on solutions for symptoms," Journal of Patient Care, v. 32, n. 8,1998, pp. 28-42.

10. Whittaker, Rosemary, "Re-framing the representation of women in advertisements for hormone replacement therapy," Journal of Nursing Inquiry, v. 5, 1998, pp. 77-86.

11. Burry, Kenneth, A., M.D.; Patton, Phillip, E., M.D., and Hersmeyer, Kent, Ph.D., "Percutaneous absorption of progesterone in postmenopausal women treated with transdermal estrogen," American Journal of Obstetrics and Gynecology, v. 180, 1999, pp. 1504-11.

12. Wood Catherine, M., MSW, CADC, "Natural Hormone Replacement Therapy" lecture, September 21, 1999.

*Pro-Gest is a registered trademark of Emerita Products, Portland, OR..