The Vancouver Women’s Health Collective’s Menopause Kit
For centuries, health information was passed down from one generation of
women to the next. Over time, however, health information became viewed as the“property” of the health professions. This led many to view medical “experts” asthe only ones who know about good health care. Contrary to this belief, we thinkthat all women have valuable information to share so that we may learn together!
Since our founding in 1972, the VWHC has promoted and supported
women helping women to help themselves! The Vancouver Women’s HealthCollective provides information, resources and other support for women toempower themselves to take charge of their own health care. Please call theInformation Centre Line 604-736-5262, if you have any health questions, or for ourhours of operation. Please come visit us at 225 – 119 West Pender Street inVancouver!
You will find we have included alternative, complementary, and more
mainstream information about menopause in this kit. Our purpose in creating thismenopause kit was to help women access a range of information aboutmenopause in order to make more informed choices about their health.
The Vancouver Women’s Health Collective would like to thank past and
present volunteers and staff for contributing to this project over the years!
Vancouver Women’s Health Collective#225-119 W. Pender St. Vancouver, BC V6B 1S5Health Information Line: 604-736-5262E-mail: [email protected] Website: www.womenshealthcollective.bc.ca
A Few Things to Keep in Mind about Menopause
Menopause is a biological, hormonal, social, psychological and cultural event
Each woman's experience of menopause is unique. Her individual
experiences need to be acknowledged, accepted and respected.
Menopause is a normal developmental stage in a woman's reproductive life. It
is not an abnormal or a diseased state.
The hormonal changes associated with menopause may cause some women
discomfort, which may be alleviated with medical, non-medical or lifestylechanges.
Each woman has the right to accurate, full and current information about
menopause, and the right to direct her own health care.
Menopause can be seen as a metaphor for endings and for new beginnings. It
provides an opportunity to reassess and to make positive life changes.
Women are empowered by knowledge and by sharing their concerns and ideas
What You’ll Find in the Menopause Kit
Herbal Remedies for Symptoms of Menopause
Bio-identical Hormone Replacement Therapy
Reading Materials and Other Resources on Menopause
Menopause is a natural transitional phase in our lives – much like the onset
of puberty – and not an illness. Menopause is a time when we experiencechanging levels of female sex hormone (estrogen) production, which leads to theend of the menstrual cycles and of our reproductive years.
Because menopause is a natural body process, the discomforts that some
women experience – hot flashes, insomnia, nervousness, depression and vaginaldryness – can often be relieved without resorting to drug and hormone therapies. There are many ways to lessen or end the physical discomforts of menopause,such as making changes in our diets, taking nutritional supplements and herbs,exercising regularly, getting enough sleep, and incorporating relaxation time intoour busy lives.
Besides dealing with the physical discomforts and emotional ups and
downs that sometimes occur during menopause, we also have to deal with otheraspects of growing older. Women who can no longer bear children may bethought to be past their “useful years”, unlike other cultures where women aremore respected for their wisdom as they grow older. Along with a loss of ourreproductive capacity, oftentimes the assumption is that we have lost our sexualityand attractiveness. It is not surprising that we approach menopause with somefear, as it is a clear signal to us that we are getting older.
We come to our menopausal years often knowing little of what to expect
because we are not encouraged to share our experience and knowledge, ingeneral, and especially between different generations of women. Nor is therealways a lot of positive information available to us in books and magazines or evenfrom the medical profession. Some members of the medical profession see thisnatural decline in hormone production as a deficiency disease and treat its signswith ovary hormone replacement therapy. What information is availableoftentimes describes menopause as something to be feared, overcome or denied.
Even though there are very real factors in our society which make the
prospect of growing older seem less than positive, for many women menopause isa time of renewal, of pursuing new interests and making new friends. It isimportant to remember that we can try to change the things in our lives over whichwe do have control. Try to learn what coping skills work for you whether it’srelaxation, meditation and/or exercise. A good support network of friends andpeers including joining a peer support group may also be helpful in dealing withthe changes that occur at this time of life. As well, you can develop a personalphilosophy that stresses the uniqueness of each stage of life and remind yourself
that life is an ever-changing experience.
Doing some or all of this can give us a new and satisfying sense of our
personal strength as well as improve our general health. Menopause can be atime of self-discovery as one phase of life is completed and a new phase, full ofchallenges and possibilities, opens up to us.
Menopause means the permanent ending of a woman's menstrual cycles
and her ability to bear children, although we usually use the term to mean thewhole period from the onset of the decline of ovarian function to the stabilization ofthe body at reduced levels of estrogen. This period is also referred to asclimacteric or the "change of life."
Menopause is the natural result of the changes in hormone production that
come with aging. When the ovaries become smaller and produce less estrogenand progesterone, egg cells die and a woman becomes infertile. Estrogen is thehormone that tells the uterus (womb) to build up its lining in preparation for theimplantation of an egg, should an egg be fertilized. Progesterone is the hormonewhich tells the lining of the uterus to shed, resulting in the monthly menstrualperiod. Menstrual flow stops when there are no longer enough hormones to buildup the lining of the uterus each month.
Menopause does not mean the end of estrogen production, but a shift from
the production of estradiol to estrone, from one form of estrogen to another. Although the production of estrogen by the ovaries decreases, the ovaries docontinue to produce small amounts of estrogen for ten years or longer afterperiods stop. As well, the ovaries continue to produce other hormones calledandrogens (androstenedione and testosterone). The adrenal glands also secreteandrostenedione, which is converted by fat and liver tissue into estrone. The morebody fat you have the more estrogen your body will produce. Perhaps the fact thatwomen tend to put on weight in their middle years is nature's way of providinganother source of estrogen when ovarian estrogen is declining.
Women experience menopause in many different ways. The period of
change is gradual, usually starting in the mid- or late-forties and lasting five toseven years. Although the signs of menopause will likely not be noticeable for thatlong, for some women periods will stop abruptly. Most women will experiencesome menstrual irregularity – missed periods, heavier or lighter periods than usual– before their periods end altogether. Menopause is usually said to be completeafter twelve consecutive months without a period. It is recommended that sexuallyactive heterosexual women use some form of birth control for two years after theirlast period. Of course the condom is always recommended for prevention ofsexually transmitted diseases including HIV/AIDS, regardless of birth controlissues.
There is a laboratory test for menopause. However, because estrogen
levels decrease gradually the test does not measure estrogen production. Ratherit measures the levels of two reproductive hormones whose levels increasemarkedly until after menopause. Women will experience the effects of declininglevels of estrogen in various ways and with varying degrees of discomfort. Itseems that the rate at which hormone levels fall off has more to do with severity ofdiscomfort than actual hormone levels. The slower the decrease in estrogen, themilder the signs. Good overall health, which includes the healthy functioning ofthe hormone-producing glands, has a role in counteracting the possibility of severemenopausal discomfort.
We live in a society where a woman's value and sexual attractiveness are
often perceived as being connected with her fertility and youth. With menopause,we lose our reproductive potential, and at the same time we are faced with theundeniable fact of aging. One myth is that menopausal women are no longerinterested in sex, or if they are, their response is inappropriate for their age. Forsome women, sexual pleasure increases with menopause, once the fear ofunwanted pregnancy and the need for contraception are gone.
Physically, it is true that with less estrogen circulating in the body, the
vaginal walls may become thinner and drier, which may make intercourse painfulor at least uncomfortable. Sexual activity, either alone or with a partner, helps tokeep the vaginal walls capable of lubricating even when they have becomethinner. There is a large emphasis on intercourse in our society, but there areother ways of being sexual and sexually satisfied. If intercourse is painful, oral ormanual stimulation can be explored.
Our ability to be sexual is influenced by so many factors: our attitudes
towards ourselves and towards sex, our general health, the availability of apartner, and our partner's attitudes. Society's ideas about menopause and agingand our own attitudes may affect our sexuality during or after menopause. Whatever your situation, menopause need not be the end of your sexuality.
Besides menstrual irregularity and the end of menstruation, there are other
signs related to menopause. Some women will experience no signs, most willhave some, and 10% will have problems of significant severity. Hot Flashes or Flushes
Over 85% of women experience hot flashes or flushes. A hot flash is
usually experienced as a sudden wave of intense heat in the skin, with sweatingand sometimes reddening of the face, neck and chest, accompanied by a rapidheart beat and followed by a chill. It can last from 15 seconds to 5 minutes andoccur only occasionally or several times in an hour.
Hot flashes can start happening before or after a woman's last period and
continue after menopause. They usually end within two years. Hot flashes are notdangerous but can be frightening, uncomfortable and embarrassing. Although it isclear that hot flashes are connected with a fluctuation in estrogen, the mechanismwhich produces the sudden vasodilatation (expanded blood vessels close to thesurface of the skin into which blood rushes, causing the sensation of heat) is notfully understood by medical science. Night Sweats
Night sweats, waking up hot and drenched in sweat, are similar to hot
flashes. Most women who experience night sweats also have daytime hot flashes. However, having daytime hot flashes does not necessarily mean you willexperience night sweats. Oftentimes tiredness, depression, and anxiety areattributed to menopause, but may result from poor sleep due to night sweats. Vaginal Dryness
Lowered estrogen levels also affect our genitourinary system. Vaginal walls
get smoother and thinner and lose some of their ability to lubricate, and the vaginallips get thinner while the cervix and uterus get smaller. This may cause an itchingor burning sensation in the vagina and intercourse can become painful. Regularsexual activity seems to help keep the vagina capable of lubricating even thoughthe walls have become thinner. Bladder Function
The cells of the bladder and urethra are also affected by menopause.
Women sometimes become more prone to bladder infections or experienceincontinence – loss of bladder control – or the need to urinate frequently at night. Premenstrual Discomfort
Many premenopausal women experience an increase in premenstrual
discomfort, which they may blame on menopause. Recent research suggests thatthe symptoms of PMS (premenstrual syndrome) may continue after the last period. It is possible that the dietary and lifestyle changes suggested to relieve thediscomforts of PMS would also help during menopause. Other Signs
Some women have reported various other problems including: headaches;
swollen ankles; insomnia; skin tingling; heart palpitations; numbness; fatigue;constipation; irritability; anxiety; depression; pain in the thumbs; memory loss;problems with vision; digestive problems; high blood pressure; new allergies orsensitivities; fluctuations in sexual desire and response; frequent urination; dizzyspells; “crawly” skin; sensitivity to touch; and the sudden appearance of facial hair. Hypothyroidism, a decrease in thyroid activity, has recently come to be reportedaround menopause as well.
Twenty five percent of Caucasian postmenopausal women will develop
some degree of osteoporosis. Osteoporosis means the bones lose density andbecome porous and fragile and break easily. Osteoporosis is associated withlowered estrogen levels and affects more women than men. Fair-skinnedCaucasian women who are also small and thin are at highest risk for osteoporosis,followed by Asian women. Other women of colour and Caucasian women withdark complexions are at lower risk, and African Canadian women are at lowestrisk.
Women who smoke, women who consume a lot of alcohol, caffeine and/or
red meat, and women who do not exercise regularly are at greater risk ofosteoporosis. The World Health Organization recommends 29 grams of proteindaily for women. Most North Americans consume 105 to 120 grams daily!Countries with the highest consumption rates of animal protein, including meat anddairy products, also have the highest occurrence of osteoporosis. Surgical removalof the ovaries doubles the risk of osteoporosis.
There is no cure for osteoporosis and treatment is aimed at slowing bone
density loss. As osteoporosis progresses, spinal fractures occur frequently, evenfrom twisting the spine or giving someone a hug. After age 65, hip fractures arecommon. Early signs of osteoporosis are:a) a progressive and persistent backache, a pain that does not radiate/spread to
other areas, in the lower part of the spine;
b) gradual loss of height due to a protrusion in the upper back; andc) periodontal disease or gum inflammation and loosening of the teeth.
Osteoporosis is known as the “silent” disease because there are rarely
signs until a lot of bone has been lost. There is now a relatively simple procedureavailable that uses ultrasound to measure the amount of bone in the heel. The“Achilles Express” test passes ultrasound through the heel. The heel is measuredbecause its bone is similar to the bone in the spine and hip, where fracturesusually occur. This test is not covered by the British Columbia Medical ServicesPlan; however, it can be obtained in some regions for a $20 to $40 fee. Theservice is available at the North Shore Menopause Information Centre (tel: 604-985-5879) for $25.
There is no medical agreement on the cause of osteoporosis. However,
some believe that calcium deficiency contributes to osteoporosis. Low calciumintake, inefficient absorption of calcium, or excessive calcium loss due to caffeineand high protein foods, which increase the amount of calcium excreted in urine
every day, may hasten osteoporosis. Some researchers focus on the role ofestrogen, which may improve calcium absorption or influence the hormones thatregulate bone remodeling. Others have focused on the role of excessive proteinconsumption, which causes the body to lose large amounts of calcium and otherminerals. Another theory is that a diet high in red meat has too much phosphorus,which disturbs the calcium/phosphorus balance.
Osteoporosis prevention starts with children and young women. It is
important to get adequate exercise and nutrition, in particular adequate amounts ofcalcium in your diet. The role of calcium supplementation for menopausal andpostmenopausal women is controversial. Some studies show that bone loss isreduced by daily calcium supplements. Other studies disagree. If excess proteinis causing the body to lose calcium, then decreasing protein consumption is moreimportant than increasing calcium intake. As well, excess calcium can lead tointernal bleeding, kidney stones and other problems. Whether to takesupplements and how much to take will depend on your diet – how much proteinand how much calcium-rich food you eat. The usual recommendation formenopausal women is 1000 – 1500 mg daily, including supplements and dietarysources.
Several forms of calcium are available. Calcium citrate is the most easily
absorbed form. Calcium gluconate is the hardest to absorb. Other forms arecalcium lactate and calcium carbonate. Some calcium rich foods include:skimmilk, low fat cheeses, yogurt, sesame seeds, tahini, sardines, mackerel, scallops,mustard and collard greens, broccoli, raw parsley, watercress, beans, molasses,tofu, carob flour, kelp, dulse, almonds, brazil nuts, dried figs, apricots andsunflower seeds. Magnesium, Hydrochloric acid, Phosphorus, Folic acid, VitaminD, and Silica are necessary for calcium absorption. Smoking, caffeine, andalcohol all interfere with calcium absorption.
Exercise may be the most important factor in preventing or slowing
osteoporosis. Regular weight bearing exercise (for at least one hour, 3 times aweek) such as walking, dancing, rope jumping, jogging, skiing, and/or cycling canincrease bone mass even in postmenopausal women.
A healthful diet may alleviate the discomfort some women experience
during menopause. By a healthful diet we mean one that is high in freshvegetables, fruit, beans and whole unprocessed grains such as whole wheat breadand brown rice, and low in meat, especially red meat, and saturated fats (primarilyanimal fats).
Vitamin and mineral supplements are considered by many people to be
essential, although they can be expensive. Most of us do not have access to farmfresh foods. Rather we rely on foods that have been brought from other parts ofthe continent and that are often processed. This means that the food we oftenpurchase is not at its nutritional peak due to processing techniques, vegetablesand fruits picked unripe, time in transport, and farming practices. Environmentalfactors and personal habits such as smoking, consumption of alcohol, and/orstressful lifestyles may also deplete the body of its vitamins.
Food allergies can initiate or worsen menopausal symptoms such as hot
flashes and night sweats. Allergic reactions can suppress estrogen function orproduction. Sometimes menopausal symptoms attributed to estrogen deficiencydisappear when the foods (or chemicals) a woman is reacting to are removed. Avoid
Red meat – which may disturb the body’s calcium/phosphorus balance.
Excess protein causes the body to lose calcium.
White sugar – it disturbs our calcium/phosphorus balance and interferes with
calcium absorption and throws off hormone balance. Women who do not eatwhite sugar have fewer and milder hot flashes. Sugar also raises bloodcholesterol levels after menopause and plays a role in many diseases such ascoronary thrombosis, diabetes and indigestion.
Food with additives and preservatives, and refined starches including white
flour, white rice, and white sugar – they provide empty calories and little or nonutrition. Chemical additives can be a danger to health. As well, constantdieting can put you at risk for osteoporosis. Reduce
Salt – too much salt leads to water retention and bloating. This increases
blood volume, which in turn leads to high blood pressure. Excessive saltconsumption also promotes the excretion of calcium, which is directly related toosteoporosis. Instead you may want to use kelp (powdered seaweed which is
rich in minerals) or salt substitutes which are made from herbs and spices. Fresh lemon juice is also good.
Saturated fats – form deposits in the arteries and reduce circulation. Animal
fats taken in excess prevent the efficient absorption of calcium and causecalcium to be leached from the bones. Consumption of excessive amounts ofsaturated fats can also lead to heart disease and hearing loss.
Alcohol – depletes the body of B vitamins, magnesium and zinc. Excessive
alcohol consumption leads to cirrhosis of the liver, heart disease andgastrointestinal disorders. As well, alcohol inhibits the use of calcium for boneformation and may trigger hot flashes.
Caffeine – depletes the body of B vitamins, potassium, zinc, iron, and Vitamin
A. Excessive caffeine increases hydrochloric acid levels in the stomach andthe chance of ulcers, overworks the kidneys, interferes with the absorption ofcalcium, contributes to insomnia, and may trigger hot flashes. Recommended Healthful Foods:
fruits and vegetables whole grains, bran, wheat germ nuts and seeds fish lecithin yogurt, buttermilk garlic, sprouts lots of fluids
Recommended Food to Inhibit Bloating:
cabbage, cucumbers, parsley pineapple, watermelon
Relaxation, Exercise and MenopauseRelaxation
Oftentimes, keeping healthy can seem like a struggle. As women, we
sometimes blame ourselves if we think we are not doing enough to live healthylives. It can be difficult to stay healthy when we are juggling busy lives. As well,we tend to place a lot of value on ways to be active and not enough on ways torelax. Constant tension can become a way of life, and is detrimental to our health. At menopause, when a woman’s body is undergoing many changes, rest isespecially needed.
Be sure to get plenty of sleep, and try to spend time during the day doing
things that are relaxing. Some women find that meditation, yoga and/or exercisegreatly increases feelings of calm and well being. There are also a number ofbooks and tapes about relaxation and relaxation techniques available at the publiclibrary or at bookstores. Exercise
Exercise is important for our physical and mental wellbeing and can delay
or prevent some unhealthy aspects of aging. Walking, swimming, dancing,cycling, or yoga are all good forms of exercise. Thai chi and some styles of yogaare a gentle form of movement suitable for women not used to exercising. Exercise improves circulation and muscle tone, bringing oxygen and nutrients toour cells. It helps with digestion and elimination, strengthens the heart, andreduces the chances of osteoporosis. Pelvic Floor Muscle Exercises
Pelvic floor muscle exercises were developed for toning the muscles of the
perineal area to improve bladder control and vaginal elasticity, and to increasesexual pleasure. Practised regularly, these exercises strengthen the pelvic floormuscles that support the bladder and uterus and can help minimize problemsassociated with urinary incontinence, which may arise during menopause.
Identifying the pubococcyygeal muscle:The PC muscle can be found by sitting on the toilet with your legs spread apart. While urinating try to stop the flow of urine without moving your legs. The PCmuscle is the one that controls the flow of urine. Your ability to stop the flow ofurine indicates how strong the muscle is.
Doing the pelvic floor muscle exercise anywhere at anytime:1. Contract the pelvic floor muscle as if to stop urinary flow. 2. Hold the position and count to five, then relax. Repeat five times for one
3. The objective is to work up to 60 exercises, or 12 sessions. Non-Drug Relief for Menopausal Symptoms
The following are a few of the non-drug alternatives that may be used to
help alleviate some of the discomforts of menopause. Hot Flashes For relief from hot flashes you may want to try the following:
Vitamin C Complex – strengthens and increases the elasticity of the capillaries.
It also helps in bone growth and to combat stress. The daily recommendeddosage is 1,000 – 3,000 mg.
Vitamin E – stimulates the production of estrogen. It may take 2 weeks to 3
months for the effects to be noticed.
Dissolve 1 cup of table salt in a bathtub of warm water. Lie in it until the water
cools. Rinse yourself with cold water and go to bed.
Wear cotton bedclothes, use cotton sheets, and sleep with the windows open.
Keep calm, loosen clothing and take slow deep breaths. Dress in layers so
that a layer may be taken off when a hot flash occurs.
Avoid hot tea and coffee, red wine, spicy foods, and foods with MSG.
Regular sexual activity – women who are sexually active on a weekly basis,
whether by themselves or with a partner, tend to be either free of hot flashes orexperience milder hot flashes than women who abstain from sex or havesporadic sex. Vaginal Dryness For relief from vaginal dryness you may want to try the following:
Vitamin E – puncture a capsule and use the oil to massage the inner sides of
Vegetable oils – safflower, coconut oil, cocoa butter, and apricot kernel oil.
Use the oil to massage the inner sides of the vagina. (Do not use Vaseline,cold cream or mineral oils as they can irritate the tissues or block secretions).
Yogurt – mix 1 tablespoon of plain yogurt with 1 teaspoon of pure cold pressed
vegetable oil, and insert the mixture into the vagina with a cream inserter oncea week.
Aloe vera, a plant-based gel, or calendula cream, made from flower petals, can
be massaged on the inner sides of the vagina. These products are widelyavailable at health food and vitamin stores.
Take 400-1600 IUs of Vitamin E caplets per day and 500-1000 IUs of Vitamin
Regular stimulation – sexual activity keeps the vaginal walls capable of
lubricating, even when they become thinner.
Bubblebath, douches, and soap make the vaginal environment more alkaline,
therefore, more friendly to yeast. Goldenseal and myrah douches areparticularly drying. Iron
The body’s ability to absorb iron decreases after the age of 40 and heavier
periods can lead to iron-deficiency anemia. It is, therefore, important to make sureour diet includes iron-rich foods such as clams, dried beans and peas, spinach,beets, chard, raisins, apricots, prunes, kelp, egg yolks, oatmeal, sunflower seeds,and molasses. Synthetic supplements are hard to absorb and may causeconstipation. If you take an iron supplement, take it with Vitamin C or orangejuice. Allow 6 to 12 hours to pass before taking Vitamin E. Liquid natural ironsupplements such as Floradix or Fera are easy to absorb and made from plantand flower derivatives, but are more expensive. Iodine
The body’s need for iodine increases at menopause. Iodine is necessary
for normal thyroid function, which is related to hormone production. Kelp(a seaweed) is an excellent and economical source of all the necessary mineralsincluding iodine. Kelp comes in powdered form and can be sprinkled in soups,salads and sauces. It is also available in tablet form. Kelp helps reduce the symptoms of menopause. Vitamin B complex
Important for combating stress. Some B vitamins increase the effect of
estrogen. A good B complex supplement or multiple vitamin and mineral tabletcontains all the B vitamins in adequate amounts. Brewer’s yeast is an excellentand economical source of all the B vitamins and can be mixed into fruit orvegetable juice or hot bouillon. Brewer’s yeast is a calcium competing mineral sotake a maximum of 2 tablespoons daily. Vitamin A
Essential for healthy functioning sex glands, as well as for resistance to
infections. Daily recommended dosage is 10,000 units. Vitamin A can be toxic iftaken in excess. Some natural sources of Vitamin A include fish oils, dairyproducts, carrots, cantaloupe, peaches, squash, tomatoes, and all green andyellow fruits and vegetables. Fem Capsules
Fem capsules may help alleviate hot flashes, night sweats, and other
menopausal symptoms. Fem 50 is an over-the-counter vitamin/mineral/ foodsupplement which includes black cohosh, Vitamin E, B6, and C, pantothenic acid,calcium, iodine, wild yam root, licorice root, false unicorn root, dong quai, passionflower, and PABA. Fem Estro is a natural support for women in menopause. FemEstro contains Vitamin E, B5, and C, bioflavonoids, PABA, raw adrenal, andginseng. Herbal Remedies for Symptoms of Menopause
The following are a few of the herbal remedies that may be used to help
alleviate some of the discomforts of menopause. There are many combinationsavailable. It is advisable to seek professional help when considering taking anyherbs with medicinal qualities. If you are taking prescription drugs please consultyour physician and share this with your herbalist. Hot Flashes
Black Cohosh – (cimicifuga racemosa). A progesterone precursor – a source
for progesterone, but not a progesterone itself - which contains calcium,potassium, magnesium, and iron. The dark root of this useful herb decreaseshot flashes, headaches, water retention and fatigue. It also tones andstrengthens uterine and bladder muscles.
Dong quai – a Chinese herb and an estrogen precursor – a source for
estrogen, but not an estrogen itself – known to nourish female glands, regulatehormones and correct menstrual problems, including hot flashes.
Evening Primrose Oil – evening primrose oil seems to have a role in stabilizing
prostaglandin production. One possible cause of hot flashes is fluctuatinglevels of prostaglandin. Many women have found relief from hot flashes bytaking evening primrose oil. It is available at health food and vitamin stores. Itis, however, very expensive.
Bee Pollen – some women have found one tablet of bee pollen a day alleviates
hot flashes. Bee pollen may also increase energy levels.
Alfalfa Tea – 2 tablespoons of alfalfa seeds to 1 pint of water taken 3 times a
day with lemon, or ¼ teaspoon alfalfa extract daily. Insomnia
Kava – may be used as a remedy for sleeplessness and anxiety.
Valerian Root (capon’s tail, English valerian) – used as a mild sleep aid.
Clinical studies on humans have shown it to safely relieve occasional insomnia.
Hops – historically hops have been used as a sleeping aid. One suggestion is
to fill your pillow with hops to sleep on. Nervousness, Anxiety, Depression, and Moodiness
Kava and Valerian Root – used for nervousness, anxiety, depression and
St. John’s Wort – used as a treatment for mild depression.
Passion Flower (maypop) – for centuries, this plant remedy has been used in
Mexico and Central America as a gentle remedy for sleeplessness. It hasbeen shown to have sedative properties and has been used in Europe foranxiety. Other Herbal Remedies
For more information about herbal remedies please see Menopausal Years:The Wise Woman Way by Susan Weed, available at the Vancouver Women’sHealth Collective. As well, The Herbal Menopause Book: herbs, nutrition, andother natural therapies by Amanda McQuade Crawford is available at theVancouver Public Library.
Over the last 20 years, there has been a growing trend toward the use of
ovarian hormone therapy. There has been a lot of "hype" about the ability ofhormone therapy to keep women young-looking and free of depression, when infact hormone treatment has no effect on wrinkling of the skin, depression orirritability. Rather, and more importantly, hormone therapy may provide relief fromthe discomforts of vaginal dryness and hot flashes.
Ovarian hormone therapy remains controversial as there are risks as well as
benefits to its use, and as there are still many uncertainties about the long-termuse of hormone therapy. A recent study by the Women’s Health Initiative of16,000 women using hormone therapy concluded that its use leads to anincreased risk of stroke (41%), heart attack (29%), and breast cancer (26%). Thestudy has resulted in many women and their doctors changing their opinions abouthormone therapy and advising against its use because of the high risks associatedwith it. Advantages of hormone therapy:
reduction or cessation of hot flashes increases elasticity and lubrication of the vagina possible prevention of loss of bone mass which can lead to osteoporosis
Disadvantages of hormone therapy:
increased risk of stroke, heart attack, and breast cancer increased risk of benign gall bladder disease in some women side effects such as cyclical fluid retention, weight gain, breast swelling and
tenderness, nausea, and migraine headaches
monthly withdrawal bleed may adversely affect triglycerides increased risk of uterine cancer if estrogen is taken without progesterone negative effects of menopause may return when treatment is ended
A woman should not take hormone therapy if she has:
a history of blood clots or stroke unexplained vaginal bleeding acute liver disease or chronic impaired liver function a history of breast or uterine cancer hypertension, stroke, or heart condition endometriosis migraine headaches gallbladder disease fibroid tumours of the uterus high triglyceride levels diabetes a smoking habit
How to Decide about Ovarian Hormone Therapy Since the topic of ovarian hormone therapy is still controversial, each woman brings to her decision her family and personal medical history, specific risk factors, priorities and concerns. The following questions may be helpful in making your decision:
1. Are the discomforts of menopause including hot flashes and/or vaginal
changes interfering with the quality of your life?
2. Have you tried non-drug alternative remedies for menopause discomforts?3. Do you have any medical conditions that could put you at high risk if you use
4. Can you tolerate possible side effects and a monthly withdrawal bleed?5. Are you at high risk for osteoporosis?6. Are you at risk of heart disease because of family history, hypertension,
smoking, or high blood cholesterol levels?
Note: Most of the above information has been adapted from the Menopausebooklet produced by the Women's College Hospital in Toronto, 1992. TheVancouver Women’s Health Collective has a copy of this booklet in our resourcelibrary. Detailed results of the Women’s Health Initiative study can be found atwww.whi.org. Bio-identical Hormone Replacement Therapy
Bio-identical hormone replacement therapy (BHRT) has received much
attention in the media as a safer alternative to other hormone therapies. Unfortunately, there haven’t been any conclusive studies conducted on BHRT totell us what risks and side effects may be associated with it. While this treatmentmay well be safer than the ovarian hormone therapy discussed above, this doesnot mean that women should use it if they can find other, non-medical ways torebalance their hormones.
Bio-identical hormones refer to hormones that are derived from naturally
occurring sources, such as soy, yams, or pigs. They are sometimes referred to as“natural” hormones. However, Premarin, a traditional hormone therapy could alsobe considered natural because it comes from the urine of pregnant mares. BHRTis not necessarily any more “natural” then traditional hormone replacementtherapy. BHRT hormones are called bio-identical because they are the same asthe hormones that women produce in their bodies. It is believed that they havefewer side effects than other hormone replacement therapies.
BHRT is sold as a gel, cream, patch, or pills, and it can contain
progesterone (Prometrium, for example) or estrogen (sold in pill form as Estrace,Tri-Est, and Bi-Est). Most women who have had breast cancer or have a familyhistory of the disease have chosen not to use BHRT because of the links betweenestrogen and breast cancer. The same questions asked about ovarian hormonetherapy on the previous page should be taken into account when considering bio-identical hormone replacement therapy.
Hysterectomy, or removal of the uterus, is a commonly used surgical
procedure for a variety of conditions. Sometimes the ovaries are removed as well. Whatever age a woman is, she will go into menopause as soon as her ovaries areremoved. Menopausal signs are likely to be severe because a woman’s body hasnot had the chance to gradually transfer estrogen production to other organs.
If a woman's ovaries, or even one ovary, are left intact during a
hysterectomy, she will experience menopausal signs somewhat earlier than mightbe expected – before she is 45 years of age – even though she has no periodsafter her uterus is removed. The same is true for women with tubal ligations.
Some women temporarily experience menopausal signs, especially hot
flashes, right after a hysterectomy, even though the ovaries are left intact. Asudden drop in hormone levels causes this in the first few days after surgery. Thisis most likely due to the temporary reduction of blood flow to the ovaries caused bythe surgery.
Studies suggest that a hysterectomy triples a woman's chance of heart
attack. The death rate from hysterectomy is higher than the death rate due touterine cancer, although a hysterectomy is sometimes suggested to prevent thepossibility of uterine cancer. The removal of healthy ovaries to prevent ovariancancer, which is a rare form of cancer, is a debatable procedure. It increases awoman's risk of heart disease and osteoporosis.
Many hysterectomies are unnecessary surgical procedures and, like any
surgery, carry the risk of complication and in a few cases, death. If your doctorsuggests a hysterectomy, especially as a preventive measure, get a second orthird opinion, and try to inform yourself about the risks and benefits.
Yes, it’s true, there are advantages to menopause! Of course the advantagesdiffer from woman to woman, but here are a few:
Heterosexually active women no longer have to worry about birth control and
You are free from premenstrual tension and the use of tampons and pads.
Fibroids shrink during menopause. Fibroids – benign or non-cancerous
growths in muscular wall of the uterus – are one of the common reasons for ahysterectomy. A woman over forty may avoid surgery by waiting untilmenopause if the fibroids are not causing pain or other problems.
Endometriosis – an often painful condition where the uterine tissue grows
outside the uterus and bleeds cyclically, sometimes forming blood-filled cysts –sometimes subsides at menopause when production of ovarian hormonesdecreases.
Fibrous breast lumps (fibrocystic breast disease) can disappear after
menopause but may reappear if a woman is taking estrogen.
Reading Materials and Other Resources on Menopause
Although we are not a lending library, women may look through the following books at the Vancouver Women’s Health Collective: Breezing Through the Change. Brown, E. and L. Walker (1994). Change of Life: Dreams and the Menopause. Mankowitz, A. (1984). The Change: Women, Aging, and the Menopause. Greer, G. (1991). Could it Be… Perimenopause? Goldstein, S.R. and L. Ashner. (1998). Dr. Susan Love’s Hormone Book. (1997). The Estrogen Decision. Lark, S. (1994). Estrogen’s Storm Season. Prior, J. (2005). Life, Love, and Sex for Women in the Middle Years - The Second Season. The Medical Management of Menopause and Premenopause. Berg Cutler, W. Menopause. Women’s College Hospital. (1992). Menopausal Years: The Wise Woman Way. Weed, Susan. (1992). Menopause and Aging. Ryan K. and D. Gibson (editors). (1971). Menopause and Emotions: Making sense of your feelings when your feelingsmake no sense. Page, L. (1993). Menopause. A Guide for Women and The Men Who Love Them. Berg Cutler,
Menopause. A Positive Approach. Reitz, R. (1977). Menopause.A self care manual. Santa Fe health education project. Lopez et
No More Hot Flashes and Other Good News. Budoff, P. (1984). The Other Awkward Age, Menopause. Page, J. (1977). The Passage Through Menopause: Women’s Lives in Transition. Millette, B.Perimenopause: Changes in Women’s Health After 35. Huston, J.E. and L.D. Stay Cool Through Menopause. Frisch, M. (1984). Supernutrition for Menopause. Gittleman, A. (1993). Understanding Menopause. O’Leary Cobb, J. (1993). Without Estrogen. Natural Remedies for Menopause and Beyond. Ito, D. Women of the 14th Moon: Writing on Menopause. Taylor, D. and A. Coverdale
Woman’s Change of Life: Dealing with the discomfort of the menopause.Journals available at the Vancouver Women’s Health Collective: A Friend Indeed: For women in the prime of life, Montreal, Quebec. Women’s Health Matters, Women’s College Hospital, Toronto, Ontario. Books available at the Vancouver Public Library: After the Change: Older Women Talk about Sex and Relationships after theMenopause. Griffin, K. (1996). The Herbal Menopause Book: herbs, nutrition, and other natural therapies. I’m too Young to Get Old: Health Care for Women after Forty. Reichman, J. Making Choices: Hormones after Menopause. Is it for me? O’Connor, A. M. Menopause, Naturally: Preparing for the Second Half of Life. Greenwood,
Menopause without Medicine. Ojeda, L. PhD. (2000). Passage to Power: Natural Menopause Revolution. Kenton, L. (1995). Web Sites:
BC Women’s Hospital and Health Centre W.H.I.M. –
A Friend Indeed Newsletter – www.afriendindeed.ca
Menopause Online – www.menopause-online.com
National Institutes of Health, Osteoporosis and Related Bone Disease –
North American Menopause Society – www.menopause.org/news.html
Vancouver Women’s Health Collective, tel: 604-736-5262
BC Women’s Hospital and Health Centre, tel: 604-875-2424
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