1. Menopause’s Mysteries
L. Z. Killinger, DC

2. 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)

3. 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!

4. 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

5. 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

6. 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:

7. 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

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

9. 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.

10. 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!

11. Trends: Breast Cancer Survival Rates
: 10 % survived 5 yrs
: 14%
: 22%
: 29%
: 44%

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

13. 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)

14. 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:

15. 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)

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

17. 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.

18. 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):
Leiberman: J Women’s Health 1998;7(5):

19. 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!)

20. “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.

21. 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

22. 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

23. 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!)

24. 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

25. Resources
(National Women’s Health Resource Center) ( )
(National Women’s Health Information Center) WOMAN (9662)
1-800 MENO-ASK National Menopause Foundation

26. Thank You!