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The average age of menopause in the US is 51.2 years of age.  The menopausal transition is the time in a
woman’s life when her ovaries cease to produce the hormones of estrogen (a.k.a. estradiol) and progesterone.  
Many women will suffer from any number of symptoms (i.e. side effects) from the withdrawal of these ovarian
hormones.

Approximately 10% of women in the United States suffer no symptoms during the menopausal transition.  
However, the other 90% will experience anywhere from mild to severe symptoms that often significantly impact the
quality of a woman’s life.


                                                  
 Most Common Menopause Symptoms

                                           Hot flashes / Night sweats                Anxiety / Depression        
                                           Insomnia                                          Irregular menses
                                           Memory problems                            Joint pain
                                           Weight gain / weight retention          Fatigue
                                           Heavy vaginal bleeding                   Thinning scalp hair
                                           Vaginal dryness                               Facial hair growth
                                           Pain with intercourse                        Dry skin
                                           Irritability                                          Dry eyes
                                           Foggy thinking                                Acne
                                           Inability to concentrate                    Incontinence
                                           Decreased interest in sex                Heart palpitations


The ovaries are not like an on-off light switch.  They are more similar to a faucet that is being slowly turned to the
off position.  As the ovaries shut down, PMS symptoms may worsen, the menstrual cycle may become irregular,
and new signs of menopause may emerge.   The slow decline of ovarian function may take up to ten years.  
Therefore, the symptoms of the menopausal transition can last this long before the menstruation actually stops.  

What’s more, after the ovaries cease to make estradiol and progesterone, menopausal symptoms generally
continue for up to two years.  Unfortunately, ten-to-fifteen percent of women will continue to have disruptive hot
flashes and night sweats into their sixth and seventh decade; this may impair their ability to sleep.  In addition,
most women suffer from vaginal dryness after estrogen production ceases.  This can be very uncomfortable, lead
to increased urinary problems and negatively impact their sexual functioning.

As medical advances continue and attention is paid to maintaining a healthier lifestyle, woman’s longevity will
continue to increase.  This means that up to 50% of a woman’s life could be lived in the post-menopausal (AKA:
the time one year after the final menstruation) period.   

There are certain disease processes that do become more prevalent once the menopausal transition has
occurred such as obesity, diabetes, cancer, osteoporosis, hypertension, heart disease, stroke, dementia, muscle
atrophy and chronic sleep deprivation.


The Strategies

As each woman progresses through the menopausal transition, there is an adjustment period she must go
through.  The question is, “How will she embrace or cope with these natural changes?”  Listed below are four
possible strategies.  They are not exclusive of each other.  Many women combine aspects of each approach to
this stage in their life. In our clinic, it is an expectation that women would be educated in all approaches to arrive
at the approach that best suits her.  

1.  Non-interference: Some women prefer to do nothing at all.  They just live one day at a time, accepting the
change as a natural transition and opt to not interfere with the process.  They may derive benefits from simple
lifestyle modifications such as instituting an anti-inflammatory diet and increase their exercise frequency.  In
general, they learn to “grin and bear” the physical, psychological and emotional symptoms of menopause as they
present.  Some may choose this pathway as they are not knowledgeable about or fear the available therapies
available to ameliorate their symptoms.  On the other hand, some just desire to take whatever “mother nature
brings to naturally”.    





























2.  Wise Woman Tradition: This strategy encourages women to embrace menopause as a natural stage of
metamorphosis and employs woman-centered botanical therapies, exercise and a whole foods-based,
phytoestrogen-rich diet in order to nourish the whole woman.  In this woman-centered approach, the menopausal
years are an opportunity for conscious change and increased personal power, not a time of failure.  


















Under the guidance of others who have transitioned before them, women are encouraged to reframe their
menopausal experience through one-on-one counseling, peer group sessions, storytelling, performance arts,
teaching others and through the written word. Reframing also introduces radically different treatments, in which
herbs are not used as natural hormones, but sources of the rich variety of helpful phytochemicals available from
nature.  Reframing menopause gives women a greater sense of self-worth.  “Loss of fertility” becomes “an
acquisition of postmenopausal zest”.  “Mood swings and depression” become a woman’s “need to spend more
time alone”.  “Aggravating hot flashes” are transformed into “movements of energy”.         

In addition to the reframing process, botanical therapies are used to help relieve menopausal symptoms, repair
bones, prevent cardiovascular disease, prevent breast cancer and prevent and treat urogenital conditions such
as incontinence, recurrent urinary tract infections and vaginal dryness.  Some examples include black cohosh for
hot flashes, headaches and nervousness, ginseng to improve energy and mood, and passion flower herb to
assist with restlessness and menopausal insomnia.  Traditional Chinese Medicine utilizes acupuncture in
combination with Chinese herbal combinations to decrease liver stagnation and therefore reduce menopausal
symptoms.

3. Medicinal Menopausal Symptom Control: This strategy focuses on medicinal control of symptoms with the
smallest dose of therapy for the shortest period of time.  The hormones that are generally monitored and
supplemented in this approach include not only estrogen and progesterone, but also testosterone, DHEA,
melatonin and thyroid.  As each of these hormones diminishes in the body, certain symptoms can arise.

  • a. Some prescription medications used to treat menopausal symptoms today were initially developed to
    treat other disease processes other than menopause, but were found to be effective in the treatment of
    menopausal symptoms.  One such example is the use of anti-depressants to treat hot flashes and night
    sweats.  

  • b. Another medicinal option includes synthetic hormone replacement therapy (HRT) of conjugated equine
    estrogen (CEE) and medroxyprogesterone acetate (MDPA), such as was used in the Women’s Health
    Initiative.  Long-term use of HRT had many benefits but also showed an increased risk of cancer, clotting,
    stroke, heart attack and Alzheimer’s.

    It is important to note that CEE is estrogen extracted from horse’s urine.  CEE contains many different
    forms of estrogen, including estradiol (E2), the bio-identical estrogen manufactured by the human ovary.  
    As noted in the following summary, estradiol has many positive effects in women’s bodies; some of the
    other forms of estrogen in CEE do not.  MDPA is the progesterone-like chemical that was commonly given
    by conventional physicians to counteract the effect of CEE, including uterine lining proliferation.  Both
    medications, CEE (AKA Premarin) and MDPA (AKA Provera) are manufactured by the same major
    pharmaceutical company.     They were the hormones tested in the WHI trial, a portion of which was
    stopped earlier than planned due to the increased risk of breast cancer and formation of blood clots.






















  • c. Bioidentical Hormone Therapy (BHT) is not the same as HRT.  BHT employs natural bio-identical
    hormones that are the same chemical composition as those that the human body makes.  Estradiol, the bio-
    identical estrogen, does increase the risk for clotting and stroke and can increase the risk for uterine and
    breast cancer if not opposed by natural progesterone.  Other than this, BHT has been much safer and
    more protective than HRT.  

    The hormones used in BHT can either be pharmaceutical grade (manufactured by pharmaceutical
    companies) or compounded by individual pharmacies.  The compounded BHT is made by a compounded
    pharmacy using the same hormones the pharmaceutical companies use.  Estradiol, progesterone,
    testosterone, DHEA, melatonin and desiccated thyroid are the hormones generally compounded by
    individual pharmacies.  BHT comes in many different forms including pills, sub-lingual applications, creams,
    oils and injections.


4.  Long-term Chronic Disease Reduction: BHT is used to acutely decrease menopausal symptoms and
continued long-term to slow the progression of chronic illness such as cardiovascular disease, diabetes, skin
changes, obesity and Alzheimer Disease.  This approach entails indefinite use of bio-identical hormone
therapy.        
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•  Use the 3-4-5 method of breathing to calm down when the heat starts to rise.  Breathe in
through your nose to the silent count of three, hold for four and breathe out through your
mouth for five.  Really focus on distending your lower abdomen with each inhalation, and count
slowly.  You should continue this pattern until your hot flash subsides.
•  Eat a healthy diet filled with vegetables, fruits, whole grains and omega-three fatty acids
(found in cold water fish, green leafy vegetables, walnuts and ground flax seed). And, sip
plenty of cool water throughout the day; this decreases your core body temperature thereby
reducing the frequency of hot flashes.
•  Avoid dietary triggers like spicy food, alcohol and most caffeine.  Although it does contain
caffeine, it is okay to drink green tea.  Here’s the trick.  Steep fresh green tea in hot water for
45 seconds, poor off that water, and then steep the same tea as you normally would.  This way
you will remove 80% of the caffeine and retain all the good anti-oxidants.  The occasional
morsel of dark chocolate is fine, too.
•  Try an herbal therapy shown to decrease the frequency and severity of hot flashes: St. John’
s Wort.  Black cohosh, although used for centuries, has not been found to be effective when
subjected to scientific analysis.   Teas containing lemon balm, hops and valerian decrease
anxiety and promote sleep, countering night sweats.
•  Use bedtime rituals to decrease disruptive night sweats.  Take a cool shower before bed,
turn on a small bedside fan, and listen to calming music.  Sleep under sheets made of 100%
cotton.  Just in case, keep a change of clothes and sheets in your nightstand to ease the pain
of awakening to drenched pajamas and soaked sheets that need changing.
•  Stop smoking.
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Contraindications to HRT

Relative Contraindications
Gallbladder conditions
Uterine fibroids
Poorly controlled high blood pressure
Endometriosis
Chronic liver dysfunction
History of thrombotic disease
Acute intermediate porphyria

Absolute Contraindications
Breast cancer
Endometrial cancers
Other estrogen-sensitive cancers
Undiagnosed vaginal bleeding
Active liver disease
Active thrombotic disease
Six Natural Hot Flash Remedies
Menopause Transition Strategies