Heal Thyself—Menopause: A Natural Journey

Although Mary Saracino and Barbralu Cohen have never met, they have much in common. They’re both Coloradans in their 50s who embrace the unconventional, particularly when it comes to health care. They’re as likely to visit an acupuncturist as a gynecologist, or to pop a homeopathic arnica tablet (Arnica montana) instead of an aspirin. So when Cohen, a 55-year-old editor in Boulder, felt the pounding of her first menopausal migraine, and Saracino, a 50-year-old Denver-based novelist, experienced her first hot flash, they decided to treat their menopausal symptoms unconventionally by following a natural treatment plan. In doing so, they chose a path taken by many American women. Since a landmark study in 2002 found that hormone replacement therapy (HRT)—the conventional, synthetic way of treating menopausal symptoms—could cause serious health risks, women and their healthcare practitioners have been searching for safer, natural and more effective remedies. According to the government-sponsored Women’s Health Initiative study, women with an average age of 63 at the start of the trial who took synthetic estrogen plus progestin for five years had a 26 percent greater chance of breast cancer, a 41 percent greater risk of stroke, and a 29 percent higher likelihood of heart attack, compared to women who took a placebo.

Those findings heavily influenced Cohen and Saracino. Cohen already has risk factors for cancer—both her mother and father survived the disease—so she’s adamant about avoiding anything that might be carcinogenic. “There’s no way I’d use HRT,” she says. Saracino doesn’t like the idea of treating menopause as if it were a particularly virulent strain of flu—suppressing the symptoms and waiting for the whole “nasty condition” to go away. “My motto is I don’t want to pathologize menopause,” she says. “When traditional HRT came out, I think the theory was that [women] shouldn’t have these symptoms, that there’s something wrong with me because I’m having hot flashes, so I need to take this pill so I don’t experience what my body needs to experience.” Cohen and Saracino have tried several different natural alternatives to HRT. Here’s a look at some of the remedies they and other women have turned to in their quest to manage their menopause symptoms.

Bioidentical hormones
Menopause occurs when a woman’s body stops producing estrogen and progesterone and is generally defined as the time after 12 months have passed since her last menses. Even though the hormone shutdown happens gradually—the entire process can take 10 years or more—bodies used to a reliable supply of hormones since puberty don’t take kindly to deprivation. They produce withdrawal symptoms such as hot flashes, headaches, insomnia, mood swings, memory loss, vaginal dryness and, sometimes, uterine fibroids. HRT was designed to lessen that withdrawal by giving the body small amounts of hormones, says Tori Hudson, ND, director of A Woman’s Time clinic in Portland, Ore., and author of Women’s Encyclopedia of Natural Medicine (McGraw-Hill, 1999). But because the hormones used in HRT are synthetic or made from substances like the urine of pregnant mares, they can create havoc when they’re introduced into a woman’s body, producing side effects ranging from breast tenderness to cancer. Bioidentical hormones are a more natural alternative to HRT. They’re made from estrogen- and progesterone-like substances in plants that are identical to the ones found in the body, so they can create fewer short-term “nuisance effects” like breast tenderness or headaches, Hudson says. Bioidentical hormones are available in creams, pills, lozenges and sublinguals (products placed under the tongue for faster assimilation). Pills generally contain the highest dosage, Hudson says. Saracino began using bioidentical hormones late last year to help control her irregular periods. Her internist prescribed a progesterone cream that did, indeed, help regulate her flow, but soon Saracino began suffering from “intense” hot flashes. “I don’t know if it was related to the [progesterone cream] or if it wasn’t,” she says. So she swapped the progesterone cream for an over-the-counter bioidentical estrogen cream. After two months on this cream, Saracino hasn’t felt any adverse effects. “It seems to help with the hot flashes and waking up with night sweats,” she says. But Hudson questions whether women like Saracino will face problems in the future from taking these types of hormones. “There is only a small amount of research on long-term side effects of bioidentical hormones,” she says. Hudson is heartened, however, by a 2004 study of 54,000 German women who took a combination of bioidentical estradiol (a form of estrogen) with bioidentical progesterone and had no increase of breast cancer risk.

Herbs and supplements As natural as bioidentical hormones may be, they still tamper with the progression of menopause, says Beth Devlin, ND, director of the Natural Family Medicine center in York, Maine. “If you keep hormones in your body, you don’t make the spiritual and emotional journey of menopause—you don’t get to the other side,” she says. Devlin recommends using bioidentical hormones for “really severe symptoms,” and herbs, supplements and lifestyle changes for everything else. But choosing the right pill, tincture or extract can be overwhelming. “I see women come in with these shopping bags full of stuff,” Devlin says. So she and other naturopaths make it easy: “If you just took one herb, black cohosh (Acteae racemosa) could potentially do the most to relieve adverse menopause symptoms,” Hudson says. She cites a 1982 study of 629 German women where 38 percent had a reduction in menopausal symptoms after six to eight weeks of taking a black cohosh preparation called Remifimin, and 49 percent had complete alleviation of symptoms. Results of a study recently published in Obstetrics and Gynecology support the 1982 findings. The newer study found that Remifimin was effective in alleviating hot flashes, vaginal dryness and mood swings. Devlin says black cohosh also can relieve two of the potential side effects of menopause: heart disease and osteoporosis. “What a lot of people don’t know is that black cohosh has a positive effect on cardiac output. It helps the heart pump blood, and it also improves bone density,” she says. As with most herbs, Devlin notes that dosage depends on a person’s weight, the severity of symptoms and the strength of the product. She generally recommends starting low and then increasing the dosage if symptoms persist. For example, a woman might begin taking 300 mg of dried black cohosh root daily, then work her way up to 2,000 mg/day. Some practitioners suggest not taking black cohosh any longer than six months until further studies are conducted on its long-term safety. The effectiveness of black cohosh is attributed to its having estrogen-like substances. Other phytoestrogens include the Chinese herb dong quai (Angelica sinensis) and soy, but “the data’s pretty mixed on soy in preventing hot flashes and night sweats,” Hudson says. Soy is also one of the top eight allergensidentified by the Food Allergy & Anaphylaxis Network, a nonprofit organization in Fairfax, Va. If you know yourself to be free of soy allergies, however, soy may help with the memory loss sometimes associated with menopause. Devlin cites a 2003 study in which 33 postmenopausal women reported improved cognitive function after 12 weeks of consuming a soy supplement containing 60 mg of isoflavones. Kava (Piper methysticum), which comes from the roots of a tropical pepper plant, has an active constituent called kavalactones that can be helpful in alleviating the anxiety and mood swings often associated with menopause. A 1991 placebo-controlled, double-blind study of two groups of 20 menopausal women found the group that took kava reported less depression and a better sense of well-being. Devlin recommends “as-needed” doses of kava following the manufacturer’s recommended intake that is standardized to 120 to 240 mg of kavalactones. To relieve insomnia, Devlin recommends 300 to 500 mg of valerian (Valeriana officinalis) per day or 1 to 3 mg of melatonin two hours before bedtime.

Acupuncture to the rescue
For Cohen, acupuncture has been so miraculous in relieving her menopausal symptoms that it merits capital letters. “Acupuncture got RID of my fibroids. My Western medical provider who first diagnosed them said they had disappeared so completely she couldn’t tell I’d ever had fibroids in the first place,” Cohen says. Cohen says acupuncture also had reduced the severe headaches, insomnia and heavy periods she’s had for the last four to five years. But acupuncture doesn’t just sedate symptoms, says Boulder-based acupuncturist David Scrimgeour. Instead, it “fixes the root of the problem [by] strengthening and tonifying the body to deal with deficiency.” Scrimgeour often places acupuncture needles in reflexology locations—an ear, or maybe even a foot—to balance a woman’s endocrine system. He says glands such as the pituitary, pancreas and thyroid produce hormones that can lessen menopause symptoms, but if they’re weakened by fighting off stress, overwork, lack of sleep or the myriad other pressures women are under today, they don’t have any reserves left to help the body cope with menopause. Scrimgeour also uses Chinese herbs to strengthen the endocrine system. He customizes herbal potions for his clients but also recommends over-the-counter brands such as Plum Flower, Golden Book Tea and Dragon Herbs. Because formulations vary, follow the dosages recommended by the manufacturer.

Ayurveda
Like acupuncture, Ayurveda treats menopause symptoms by addressing imbalances throughout the body. According to this ancient Indian healing philosophy, the body has three doshas, or types of energy: vata, pitta and kapha. “Women in their reproductive years have a tendency to express more pitta forces, and most of the menopausal symptoms are related to pitta accumulation,” says David Simon, MD, medical director and cofounder of The Chopra Center in Carlsbad, Calif. Simon says because pitta is the fire dosha, it can be the culprit behind hot flashes and dry body tissues. There’s also a theory that it literally cooks the body, causing heart disease and dry, brittle bones. To treat pitta imbalance, Simon recommends meditative exercises such as yoga. “Pitta is a form of stress response,” he says. “Conscious use of breath can release stress.” It also helps to avoid pitta-increasing spicy, sour or salty foods and load up on pitta-pacifying sweets, bitter foods such as dark leafy greens, and astringent foods such as lemons or cabbage. Simon also recommends Ayurvedic herbs such as shatavari (Asparagus racemosus), a wild form of asparagus that has been shown in studies to reduce uterine spasms; and amalaki (Emblica officinalis), which has anti-inflammatory properties.

The other side
Cohen has had menopausal symptoms for five years; Saracino for two. Although they look forward to completing the menopause process, they both embrace the power this life change has brought them. “I think there’s a way we step into our own skin through menopause—maybe it’s because we’ve gone through this whole process and our bodies have really changed. It’s almost like a birthing on the other end,” Saracino says. Adds Cohen, “I’m very interested to see what happens when all my energy and chemistry isn’t going into producing an egg every month. I’m really excited to see where my energy and focus can go when I’m done with this.” Thanks to Alternative Medicine Magazine for This Article!