Menopause’s Mysteries L. Z. Killinger, DC

Recommended Reading The Wisdom of menopause: Creating Physical and Emotional Health During Change- Christine Northrup The Seven Sacred Rites of Menopause- Kristi Meisenbach Boylan ($9.50 Amazon.com)

Why is this important? Over 1 in 3 US women are over 50 years old! That means this is a hot topic for your patients!

What Patients May Experience Missed periods (pre-menopause) Chills/Hot flashes or sweats Flushes Dizziness Wooziness Palpitations Sleep disturbances Sexual symptoms Mood swings, anxiety, panic attacks, overreacting! Maybe: Depression, memory loss, skin wrinkling, fatigue, thinning of hair, stiffness in joints and muscles

When Does It Occur? Average Age: 50-51 Years old Usual medical treatment: Hormones ERT/HRT (WARNING!) Assessment: Blood test: Follicle Stim. Hormone (FSH) Menopause Defined: No menstruation for 12 months = The definitive diagnosis

Can we predict menopause? Missed periods: Most reliable predictor Missed a period: 65% will have menopause within 2 years; 100% within 4 years Other predictors like hot flashes, not nearly as reliable. Source: Taylor, et al. Menopause. J N Amer. Menopause Soc. 11: 40-45.

Perimenopause Age 44-51: ( The 8 yrs before menopause Estrogen declines more rapidly (Adjust w/care!) Decline in childbearing potential (Careful!) First, menses comes more often (YIKES!) Then, menses becomes irregular Bleeding may become heavier Hot flashes-usually 1-4 years before menopause (worse at night) Insomnia, irritability, forgetfulness, sexual symptoms

Post-Menopausal Health Risks Increased risk of: Heart disease Osteoporosis Uterine cancer Breast cancer Ovarian cancer Depression Colon cancer, etc, etc.

What can we do? Bone Density Loss: Counsel pts. about physical activity, diet, and supplementation, and lifestyle choices Heart Disease Risk Increases: Counsel pts on physical activity, Mediterranean diet, supplements, etc. Depression/Anxiety: Counsel pt about physical activity, socialization, volunteering, etc.

What can we do ? Uterine cancer-Low fat diet, control weight and diabetes, regular pelvic exams. Colon cancer-Fiber 30 g/day, regular screenings, calcium supplements Breast cancer-physical activity, weight loss, low fat diet, lower alcohol intake, no smoking! Regular exams/self-exam!

Trends: Breast Cancer Survival Rates 1974-79: 10 % survived 5 yrs 1980-84: 14% 1985-89: 22% 1990-94: 29% 1995-2000: 44%

Why are survival rates up? EARLY DETECTION!! Mammography Treatment (chemo.) in earlier stages Source: Giordano SH. Cancer. Jan 04; 100:44-52

Why not take HRT? The Women’s Health Initiative study (large study on HRT for postmenopausal women) cancelled the arm of the study in which women were taking HRT (Estrogen/Progesterone combined) After 5 years women taking HRT had increases in several diseases. The risks of HRT were shown to outweigh the potential benefits (Slightly decreased incidences of colon cancer and hip fractures)

Increased Risks of HRT (When taken for > 5 years) Heart Attack: 3.7/1000 women instead of 3 Stroke:2.9/1000 women instead of 2.1 Blood Clots in Legs or Lungs: 3.4/1000 instead of 2.6 Breast Cancer: 3.8/1000 instead of 3 But, decreased risk of osteoporosis and perhaps colorectal cancer JAMA 2002;288:872-881.

Herbs and Menopause For thousands of years eastern healers have observed that some herbs have a positive impact on female troubles, including menopause Although used for centuries with success, such products are now being scrutinized using the scientific method (Experimental studies, placebo studies, controlled clinical trials)

Herbs for Menopause Soy products (isoflavones) Black cohosh Wild yam Clover Ginseng Licorice Dong quai AND…Vit B6, B9, etc.

Which Herbs/For What? Herbs For Bone Loss: Wild Yam: natural progesterone source Chaste Berry-LH/Progesterone stimulant Red Clover: All 4 isoflavones Daidzen, Genistein, Formononetin, Biochanin Source: Nestel et al. J Clin Endocrinol Metab. 1999; 84(3):895-8.

More Herbs Black Cohosh: <Remifemin> Used for relief of general menopausal symptoms, nervousness, anxiety, hot flashes, vaginal dryness Resources: Whiting, Clouston, Kerlin. M J Australia 2002;177(8):440-443. Leiberman: J Women’s Health 1998;7(5):525-529.

More Herbs Passion flower: Sedative and anti-spasmodic, for female anxiety, restlessness, insomnia, and night sweats of menopause Alfalfa: Hot flashes, insomnia, night sweats, dizziness, etc. Soy isoflavinoids (eat more soy!)

“Tending and Befriending”: How Women Handle Stress Recent study showed that men and women respond to stress differently (Duh!) Men either behave aggressively, or seek solitude Women ‘tend and befriend’: Clean, organize, call friends, call on female friends Women that have close female friends live healthier, longer after traumatic injury/event, etc.

So, what does this mean to us? Encourage women, who are stressed over menopausal changes to do what comes natural: ‘tend and befriend’ Avoid caffeine: Increases insomnia, night sweats, breast cysts, bone loss, etc. Avoid alcohol-Increases breast cancer risk, depression, bone loss, etc Volunteer, socialize, stay active, eat right, try natural remedies, talk to others

Encourage a Diet “Consciousness” Increase water consumption Decrease fats in diet Increase fruits/veggies in diet (for female cancer prevention in general) Increase fiber in diet-protects colon health (helps w/ mood?) Increase Calcium, Vitamin D, Soy

Encourage Physical Activity Encourage Physical Activity! (So, you thought we might get through a day without hearing this again, eh?) Decreases stress Increases muscle mass and bone density Decreases pain Improves mood/decreases depression Decreases blood pressure and heart disease risk Improves overall health status, balance, self -image, sex drive, etc!!! (Stay tuned for more benefits!)

Advantages of Menopause Freedom from birth control (finally!) Sex with no fear of pregnancy Protection from anemia (chronic problem with many menstruating women) Feeling of independence for women Hormonal “stability” after a lifetime of fluctuation

Resources Www.healthywomen.org (National Women’s Health Resource Center) (202-537-4015) www.4women.org (National Women’s Health Information Center) 1-800994-WOMAN (9662) 1-800 MENO-ASK National Menopause Foundation

Thank You!