Especially for Women Part 2- The Hot and Dry of Menopause
Hot flushes are one of the more common reasons women seek help during menopause.....
Especially for Women Part 2
The Hot and Dry of Menopause
by
Isla Burgess MNZAMH MNHAA
Hot flushes are one of the more common reasons women seek help during menopause.
The cessation of the Oestrogen plus Progestin trial in the USA by the National Institutes of Health, published in JAMA 2002; 288 has meant that more women are now looking for alternatives to Hormone Replacement Therapy (HRT) for the treatment of menopausal symptoms.
After oestrogen levels reduce at the beginning of menopause, both the adrenal glands and ovaries take over the function of producing an androgen (male hormone) which is then converted to an oestrogen called oestrone in the muscle and fatty tissues. If the adrenal glands are under pressure due to the effects of stress then their ability to produce the androgens may be compromised.
Good diet, digestion, absorption and assimilation improve the woman's ability to nourish herself optimally and improving liver function assists in her to be able to cope with higher than normal levels of Lutinising hormone (LH) and Follicle stimulating hormone (FSH) during the early stages of menopause.
So looking for ways to reduce stress (such as exercise, breathing techniques and calming herbal infusions like chamomile and lemon balm) will help. Even a liquorice 'T' bag will have a mild effect on improving adrenal function.
Using some dandelion root vinegar will improve digestion, mildly stimulate liver function and improve the ability to absorb nutrients.
About hot flushes?
Hot flushes are experienced by approximately 75% of women going through menopause. For more than half of those the symptoms are mild, a little annoying or occasionally even a pleasant state of warmth. For others they can be more severe, disturbing sleep, triggering feelings of ‘loss of control', causing excessive perspiration, loss of concentration and just plain uncomfortable. Triggers can be emotional states such as feeling upset or excited, tiredness, hot or spicy food, hot baths and stress.
Having worked with a large number of women clinically I see two groups emerging;
• those in the first year after the last menstrual period
• those 1-5 years after the last menstrual period
Contrary to much of what is written many women continue to have hot flushes for up to 5 years.
In the first group the ‘flushing' is related to changing levels of hormones, the more dramatic the drop the more severe the symptoms. Women whose menopause is triggered by surgery generally have more severe symptoms. Many women describe having an ‘aura' before the flush which is a momentary sensation of nausea or unease or panic which quickly passes before the flush. Most women experience episodes of flushing with intervals of no flushes.
In the second group, stress is more commonly the trigger. They may occur all the time, or on just the odd day. Some women can trigger a hot flush just by thinking about a recent ‘emotionally charged' event.
What causes hot flushes?
It is thought that Lutinising hormone ‘increases because of a flurry of activity in the Hypothalamus and the release of Gonadotrophin Releasing Hormone'
A recent study showed serotonin concentrations in menopausal women are related to the severity of symptoms.
Serotonin levels are significantly lower in women with medium to severe symptoms. High concentrations of serotonin are linked with feelings of calmness and well-being and low levels with an increase in depression, anxiety and sleeplessness and other menopausal symptoms. It is interesting to note the relationship here between serotonin levels and disturbances in the digestive tract. 90% of serotonin is found in certain cells in the digestive tract.
Serotonin is increased by eating carbohydrate foods and – wait for it - chocolate! Vitamin C and B6 are required for the synthesis of serotonin from tryptophan.
It is also interesting to note that several women have described feeling depressed on the currently popular high protein, low carbohydrate diets.
So what herbs do herbalists consider?
Black cohosh Cimicifuga racemosa
This herb has been the subject of a number of clinical trials with some conflicting results. A summary of these indicates that it is ‘…as active and as effective treating the most common menopausal symptoms as oestrogens' . The symptoms were described as mild to medium and were hot flushes, nervousness, night sweats, depression and insomnia. Interestingly at a conference on Herbal Medicine in Thailand in 2002 a paper on Cimicifuga racemosa focused on its effect on raising serotonin levels. My personal opinion is that positive results are dose related and product dependent. It does appear to be acting as a SERM, a selective oestrogen receptor modulator and can therefore target certain oestrogen responsive tissues. Black cohosh is sometimes marketed as Remifemin.
Ginkgo Ginkgo biloba is often not considered as a key herb but it should be as it improves circulation to the head, improves memory and mood, increases peripheral circulation, reduces the enzyme that is responsible for the breakdown of serotonin and improves libido in women.
St John's wort Hypericum perforatum is considered for both its nervine tonic effects as well as its ability to increase serotonin levels.
Wild Yam Dioscorea villosa is prescribed by many practitioners for women either as Wild Yam Cream or Natural Progesterone Cream. There is a lot of misunderstanding about this plant and the creams. Firstly the chemical constituent diosgenin as in Wild Yam Cream and in the plant does not trigger progesterone receptors but will trigger oestrogen receptors. To make ‘Natural' Progesterone Cream the diosgenin is converted into a progestagen chemically . It is not ‘Natural'!
It was popularised by Dr. John Lee (US) who felt that treating women with menopausal symptoms for low progesterone levels was as important as considering the lowering of oestrogen levels. There is little good research to support its use. It may be that some women benefit from using ‘Natural' progesterone cream but it is not for everyone and it is definitely not ‘Natural'. It is a synthetic hormone and we do not have any long term studies on its uses or effects.
Red Clover Trifolium pratense found in many of the over the counter preparations such as Promensil. They do contain plant oestrogens that can trigger oestrogen receptors.
Generally a herbalist would not prescribe one herb for women seeking help with hot flushes but would prepare an individualised formula of a number of herbs.
Generally my advice depends on the severity of your symptoms.
For those with mild symptoms, include dandelion root vinegar before meals, eat lentils 2-3 times per week, fish 2 times a week, eat a balanced diet of vegetables and fruits, be aware of food sources of calcium, magnesium, boron and silicon, exercise regularly, drink water, engage in some challenging mind exercise and have time for relaxation (Meditative techniques, Yoga, breath work).
For those with more life affecting symptoms, consider a herbal formula for three months, along with the above dietary and lifestyle advice.
For those with severe lifestyle altering symptoms the above are important but you may need to consult appropriate health practitioners to work out the best approach for you.
To prepare Dandelion root vinegar.
This is a good time of year to do this.
Identify and dig several roots of dandelion (Taraxacum officinale). Clean and chop finely. Just cover with organic apple cider vinegar and leave for 10 to 30 days. Strain and take 1 dsp. in water before two meals or use in salad dressings.
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