Women’s Health: A Naturopathic Approach

WOMENS HEALTH A NATUROPATHIC APPROACH:  Menopause, Perimenopause and Associated symptoms

By Dr. Sunil Mam, Naturopathic Doctor

Menopause: The term menopause is the permanent cessation of menstruation following the loss of ovarian activity after 12 consecutive months of no menses following the final menstrual period. Menopause has been estimated to be between 50 and 52, has remained same in the last few centuries.

Perimenopause: This period is immediately before menopause. Perimenopause initiates with changes in the menstrual cycle and ends 12 months after the final menstrual period. It is generally characterized by the menstrual cycle length to vary from the normal cycle and irregular bleeding. The average age of onset of the perimenopause or menopause transition is age 47.5. For most women, this transition lasts about four to five years.

Factors influencing Menopause:

Three essential factors impacting the age of menopause include current smoking, familial factors, and genetic factors involving the estrogen receptors. Other factors influencing menopause include increased body mass index (being overweight), history of no pregnancy, chemical exposures, treatment of childhood cancers with chemotherapy and radiation, epilepsy, and cognitive scores in childhood (the higher the score, the later the menopause). There appears to be no link between age of menopause and history of hormonal contraception, socioeconomic or marital status, race, or age of first menstrual cycle.

Other Forms of Menopause:

1. Premature menopause (also called premature ovarian failure, or POF) is a combination of secondary amenorrhea, menopausal symptoms, and a persistent elevation in follicle-stimulating hormone (FSH) levels greater than 20 IU/L before 40 years of age may develop in one in hundred between ages of 15-40.
2. Induced menopause is when the menses stops after surgical removal of both ovaries including ovariectomy or bilateral oophorectomy and may or may not include the removal of the uterus (hysterectomy). The onset of menopause is immediate in such patients.

The Physiology: Perimenopause leading to Menopause

• Ovaries have reduced response to FSH &LH, cause shorter follicular phase, shorter &more irregular menstrual cycles with fewer ovulation.
• Reduction in progesterone synthesis due to decrease in follicle response and maturation & corpus luteum generation. This leads to dominance or excess of estrogen activity-estrogen dominance.
• Overtime estradiol production decreases and does not suppress LH & FSH secretion.
• Extra gonadal synthesis of estrogen, predominantly estrone
• Eventually ovaries are unable to elicit a response to pituitary gonadotrophins. Typically, during menopause estrogen levels fall slowly (exposed to lot of estrogen: commercially raised meat, pesticides, plasticizers …) while progesterone levels fall drastically

Signs and Symptoms:

Perimenopausal women can experience menstrual irregularities, hot flashes, vaginal dryness and thinning, skin changes, fatigue, decreased libido, mood swings, depression, changes in memory and cognition, sleep disturbance, hair loss on the head, hair growth and acne on the face, heart palpitations, nausea, headaches, urinary tract infections, joint pains, and the beginning stages of osteoporosis and heart disease.

During Menopause: 75-90% of women will have transient symptoms that resolve within 4-7 years without any treatment. Vaginal dryness and thinning and problems related to this tend to persist and in fact can get worse with time. The most common prevalent symptoms are:

•  Vasomotor symptoms (hot flashes and night sweats)
•  Sleep disturbances
• Urinary problems (urinary leakage, urinary urgency, urinary frequency, infection, pelvic relaxation) Headache
• Mood swings
• Depression and anxiety
• Memory changes
• Sexual function
• Mouth & eye dryness
• Fatigue
• More rare symptoms might include voice impairment, shoulder problems, and numbness and tingling sensations, dizziness, and nerve pain.

Hot flashes are sudden, transient episodes ranging from just feeling warm or overheated to intense heat and perspiration. Typically described as a wavelike sensation over the body, predominantly on the upper torso, face, and head.  Hot flashes occurring at night also associated with what can be drenching perspiration, is then termed night sweats. Its mechanism is poorly understood however low estrogen, or it is possible that lower levels of estrogen and progesterone cause a withdrawal of opioids, triggering a hot flash.

Estrogen affects numerous neurotransmitters in our brain, including acetylcholine, serotonin, noradrenalin, and dopamine. All of these have influences on concentration, mood, learning, and memory.

With estrogen loss, the vagina also shortens and narrows, and the vaginal walls become thinner, less elastic responsible for vaginal dryness, vaginal discharge, and pain with intercourse. As estrogen levels decline, the end of the urethra, becomes shorter, reduces our defense against the bacteria thus may cause urinary tract infections (UTI). Lower estrogen levels also cause our vagina, urethra, and bladder to become more alkaline, which also leaves these areas prone to infections.

Hormonal changes in menopausal women are probably associated with an increase in insulin resistance, leading to increased fat storage, increased abdominal fat, and weight gain.

In postmenopausal women, there are several chronic medical conditions that may develop because of the changes in their bodies. These may include:

• Cardiovascular disease: as estrogen levels reduce, heart disease is the leading cause of mortality in women. Lifestyle changes, focusing more on exercise, healthy diet, and quitting smoking can all greatly reduce your chances of developing this chronic condition.
• Osteoporosis: bones become brittle and weak and can lead to an increased risk of fractures. Bones lose their density at a rapid rate. Postmenopausal women are at an increased risk of hip, wrist and spinal fractures. Getting adequate calcium and vitamin D, strength-training and weight-bearing exercises, such as walking, and jogging can be of help.
• Incontinence. Changes to the tissues in your urethra and vagina may lead to sudden, strong urges to urinate along with leakage, or the loss of urine when doing something that stresses your abdomen, such as coughing, laughing or lifting.
• Weight gain. You may find, along with many other postmenopausal women, that you need to eat less to maintain your normal weight.

Role of Naturopathic Doctor in Managing Perimenopause & Menopause:

The alternative approach to menopause is to provide relief from common menopausal symptoms and to prevent and/or treat osteoporosis, heart disease, and other diseases of aging to reduce the risk of breast cancer, blood clots and strokes. It is distinct in that the evaluation of each woman lends a great deal of attention not only to individual symptoms, but also to her individual risks for future diseases.

Treatment considerations include a spectrum of options. The treatment categories are:

1. Diet, lifestyle and stress management:

• A diet rich in whole natural and unprocessed foods, more fruits, vegetables, whole grains, beans, seeds, nuts, and healthy fats, and low in saturated fats, fried foods, white flour, alcohol, sugar, and salt.
• Soy: high in phytoestrogens, although their benefits may be more for preventing osteoporosis, heart disease, and even breast cancer than for the relief of menopause symptoms such as hot flashes.
• Flax seeds: significant dietary source of phytoestrogens.
• Bone Health: insufficient calcium intake, vitamin D deficiency, low calcium and high phosphorus intake, low fatty acid intake, insufficient dark leafy greens, a high-protein diet, excess salt intake, and excess alcohol.
• Heart Health: Lowering the level of trans fats and saturated fats while increasing omega-3 fats and monounsaturated fats from olive oil are keys to a nutritional preventive approach to heart disease.
• Common triggers for hot flashes include hot drinks, spicy foods, alcohol, and warmer temperatures.

Lifestyle

• Get regular exercise. 30 minutes a day of physical activity, moderately intense, can help protect you against many of the conditions associated with aging, including cardiovascular disease, diabetes, osteoporosis, and others
• Don’t smoke. Raises the risk for different cancers, heart disease, stroke, and many other health problems, smoking can bring on early menopause and increase hot flashes.
• Dressing in layers can be helpful for hot flashes.

Ways to reduce stress and maintain calm:

• Walk with a friend, join a yoga class, bike, hike—whatever you enjoy, exercise is a great way to reduce stress and stay healthy.
• Share your concerns with a family member, good friend, healthcare professional, or counselor.
• Eat well.
• Avoid caffeine and alcohol.Herbal tea (iced, if hot flashes are bothersome) provides a soothing alternative to caffeinated drinks (caffeine elevates levels of cortisol, the “stress” hormone). Although alcohol may make you feel relaxed and drowsy, it has been shown to interfere with sleep quality
• Adequate sleep is necessary for alert functioning during the waking hours. Most adults require between 6 to 9 hours of sleep per night. Try to determine your sleep needs and then get as much as you need.
• Relax learn the techniques of deep breathing and meditation
• Enjoy a good book, music, or a favorite hobby. Find a creative outlet by enrolling in an art or music program.
• And don’t forget to laugh and smile at every opportunity!

2. Nutritional supplementation:

• Based on a thorough assessment the Naturopathic Doctor may recommend the following supplements that are scientifically proven beneficial to the patients dealing with Menopause.
  • Bioflavonoids: rutin, hesperidin, and quercetin, are usually known for their antioxidant and anti-inflammatory properties and their ability to strengthen capillaries in combination with Vitamin c will help reduce hot flashes.
  • Pyridoxine: An insufficiency of vitamin B6 may also cause insomnia and irritability. Since depression, insomnia, and irritability are typical menopausal symptoms, this vitamin may be a helpful addition
  • Evening Primrose Oil: has a reputation for alleviating vasomotor symptoms such as hot flashes.
  • Gamma-Oryzanol: Gamma-oryzanol be effective in relieving menopausal hot flashes
  • Vitamin E.: reputation of vitamin E as a remedy for hot flashes
  • 5HTP and Melatonin for mood and sleep issues respectively.

3. Botanical supplementation:

• After having done a complete and thorough evaluation the Naturopathic Doctor may prescribe the following Botanical herbs for your wellbeing.
• Dong Quai (Angelica Sinensis). It has predominantly been used as a female remedy to treat menopausal hot flashes.
• Ginkgo can be used for memory issues,
• Ginseng, Licorice, red clover for vasomotor symptoms, Black Cohosh, chaste tree, St. Johns wort, salvia officianalis for hot Flashes, mother wort, valerian, kava, maca, hops, burdock, ashwagandha to mention the main ones to the exhaustive list.

4. Homeopathy: is an alternate system of medicine that treats people as individuals. Taking into consideration physical symptoms, sleep and energy patterns, responses to weather, emotional triggers, and food sensitivities is important in determining the correct treatment. The correct homeopathic remedy will stimulate one’s entire being to return to homeostasis (a state of balance). This means that your menopausal symptoms will diminish, and your entire system will feel more comfortable with the changes.
5. Traditional Chinese Medicine- Acupuncture TCM can use unique theories to interpret the diversified & subtle nature of symptoms and correlate them with internal disharmonies.  Menopause is a deep energy shift extending beyond physical changes. It is recognized as a natural and normal part of a woman’s life; however, it has the power to affect woman’s mind, emotions and spirit.  Qi naturally declines as we age. Kidney energy deficiency is considered one root cause of menopausal issues.  Kidney energy powers the many functions of the body. TCM recognizes menopause as part of the natural aging process and is often termed Kidney Yin Deficiency however a thorough evaluation and establishing a clear diagnosis and working on the disharmony through acupuncture and herbs may be helpful in dealing with symptoms of menopause.
6. Compounded bio-identical hormones: Considering patients symptoms Hormonal therapies including topical /suppository estrogen and or topical /suppository progesterone (permissible to be prescribed by naturopathic doctors in Ontario) can be utilized by the Naturopathic doctor in the lowest dose, shortest duration, and safest way possible that meets the goals that have been identified.

References:

1. Hudson, Tori. Women’s Encyclopedia of Natural Medicine: Alternative Therapies and Integrative Medicine for Total Health and Wellness. McGraw-Hill Education.
2. The Society of Obstetricians and Gynaecologists of Canada. The Menopause Handbook. February 2006. Available at sogc.org
3. com. Menopause: Definition. Accessed August 2, 2010. Available at www.mayoclinic.com/health/ menopause/DS00119
4. com. Menopause: Causes. Accessed August 2, 2010. Available at www.mayoclinic.com/health/ menopause/DS00119/DSECTION=causes
5. com. Menopause: Complications. Accessed August 2, 2010. Available at www.mayoclinic.com/ health/menopause/DS00119/DSECTION=complications
6. com. Menopause: Treatments and Drugs. Accessed August 2, 2010. Available at www.mayoclinic. com/health/menopause/DS00119/DSECTION=treatments and drugs
7. S. Department of Health and Human Services, Office on Women’s Health. Understanding Menopause. Accessed August 2, 2010. Available at www.womenshealth.gov/menopause/
8. com. Menopause: Lifestyle and Home Remedies. Accessed August 2, 2010. Available at www. mayoclinic.com/health/menopause/DS00119/DSECTION=lifestyle and home remedies
9. https://www.pfizer.ca/sites/g/files/g10017036/f/201410/Menopause.pdf
10. Functional and Personalized Hormone Restoration Therapy-LP3 Network
11. https://www.webmd.com/menopause/guide/guide-perimenopause#1
12. https://www.webmd.com/menopause/guide/menopause-hormone-therapy#1
13. Treating hot flushes in menopausal women with homeopathic treatment–results of an observational studyBordet MF¹, Colas A, Marijnen P, Masson J, Trichard M.