Menopause related articles.

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  • Hot Flashes No More
  • Premature Ovarian Failure
  • Photoestrogens

  • Hot Flashes No More
    written by Dr. Love

    Six to 12 months without a menstrual period is the commonly accepted rule for diagnosing menopause. Classic symptoms include hot flashes, skin wrinkling, vaginal dryness, headaches and night sweats.

    Menopause is thought to occur when there are no longer any eggs left in the ovaries, This "burning out" of the ovaries reflects the natural course of events. At birth, there are one million eggs. This number drops to about 300,000 or 400,000 at puberty, but only about 400 eggs actually mature during the reproductive years. By the time a woman reaches the age of 50, few eggs remain.

    Hundreds of years ago, women relied upon their intuition and Mother Nature to keep themselves healthy, The conventional medical treatment of menopause disregards this factor and primarily involves the use of hormone replacement therapy (HRT), whereby a combination of estrogen and progesterone is utilized to control symptoms.

    During the 1940s and 1950s, estrogen was widely prescribed to help women cope with the symptoms of menopause. By the 1970s, estrogen replacement therapy became firmly entrenched as the medical treatment of choice for women in menopause. Unfortunately, the consequences of long-term estrogen therapy were not well understood at that time.

    It is now well established that estrogen replacement therapy is associated with a 4-13 times increased risk of developing endometrial cancer (cancer in the lining of the uterus). To combat this tendency, drug companies and physicians began recommending that estrogen be combined with progesterone, Estrogen replacement therapy thus became hormone replacement therapy. And hormone replacement therapy carries with it the risk of causing other cancers.

    The Physicians Desk Reference (as do the package inserts for estrogen and progesterone products) provides a long list of side effects of HRT. In addition to the well-known risk of cancer, estrogen and progesterone increase the risk of blood clots, breast tenderness, PMS- like symptoms, depression, uterine fibroid enlargement, fluid retention and headaches.

    Fortunately, herbal medicine and the use of botanical extracts can provide effective, long-term relief of such symptoms.

    The use of short-term (less than 6 months) hormone replacement therapy for menopausal symptoms provides only temporary relief. It is not a permanent cure; it only delays the inevitable. Long-term hormone replacement therapy is not justified in most women (exception; women with severe osteoporosis) because its risks outweigh the benefits. Breast cancer is the form of cancer most likely to be exacerbated by hormone replacement therapy. In 1998, it is also the most common cancer in women.

    Thus HRT is not advised for women who are at high risk for breast cancer or women with a disease aggravated by estrogen, including breast cancer, active liver diseases, and certain cardiovascular diseases.

    I am always fond of recommending high-quality formulations of standardized herbs, and those which are prepared in combination. Nowhere is that more important than in your natural approach to menopause. It is in the setting of synergistically blended formulations that one herb enhances the effects of another thereby producing a more profound effect on a woman's health. A healthful lifestyle is vital, fun, exciting and most importantly, free of the bothersome symptoms of menopause.

    Here are the five most common nutrients I suggest to women who are suffering from symptoms of menopause:

    Dong guai (Angelica sinensis) Called the "female ginseng", it helps balance levels of your two major hormones: estrogen and progesterone. It also stabilizes blood vessel walls, eases PMS symptoms and can ease heavy bleeding. Dong Quai is also an analgesic, antibacterial and a smooth-muscle relaxant.

    Chasteberry (Vitex agnus castus) Native to the Mediterranean, chasteberry helps balance your hor- monal swings as well as hot flashes, vaginal dryness, heart palpitations, night sweats and headaches.

    Black cohosh (Cimic~ia racemosa) I have to thank my grandmother for introducing me to this one. This herb was first used by Native American women hundreds of years ago and now is a very popular alternative to HRT in Europe. It is the most well-documented natural alternative (trade name: Remifemin) to HRT and effectively relieves all menopausal symptoms.

    Licorice root (Glycyrrhiza glabra) Licorice balances your hormonal levels of estrogen and progesterone ratios, helping to ease hot flashes, mood swings and vaginal dryness. It is useful for treating fatigue since it also helps replenish your adrenal glands.

    Soy "The Bean" is finally gaining popularity in this country. It keeps your vaginal tissues moist and healthy, counters hot flashes and protects against cancer (animal studies show activity against breast cancer) and heart disease. With regards to cardiovascular disease, soy lowers blood levels of LDL cholesterol when consumed at levels of about 45 grams or more per day.

    Whether or not you're taking hormone replacement therapy, it's perfectly safe to try herbs if you're experiencing menopausal symptoms (hot flashes, vaginal dryness, fatigue). I urge you to consider taking herbs if:

    Your menopausal symptoms are mild but you'd like relief
    You don't want to take HRT because of breast cancer risk or other concerns

    You're on HRT but would like the added benefits of herbs

    References: (for additional scientific viewpoints)
    Birkenfeld, A. and Kase, N.G., "Menopause Medicine: Current Treatment Options and Trends," Comprehen Ther 1991; 17:36-45.

    Bergkvist, L. and Perssson, I., "Hormone replacement Therapy and Breast Cancer: A Review of Current Knowledge," Drug Saf 1996; 15:360-370.

    Warnecke, G., "Influencing Menopausal Symptoms with a Phytotherapeutic Agent," Med Welt 1985; 36:871-4.

    This information is for educational purposes only. It is not intended to treat, diagnose, cure or prevent any diseases. Dr. Love is a practicing M.D. with over 15 years of experience. Dr. Love has acquired a 15-year history with the use of natural medical therapies and is the author of the critically acclaimed book Sudden Death. Dr. Love endorses the importance of nutritional supplementation in his active practice and conducts educational seminars.

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    Premature Ovarian Failure (POF)

    POF is estimated to affect 250,000 American women which represents approximately 3% of women between 15-39. The average age of onset is 27.

    WHAT IS PREMATURE menopause? Better called "premature ovarian failure" (a term many patients with this condition prefer) or "POF," this is menopause which occurs for any reason before the age of 40 as a result of lost ovarian function. For most women with POF, the cause of their condition is never identified. Known causes of premature menopause include: autoimmune disorders (most common), genetic factors, chemotherapy, radiation, surgical removal of the ovaries for any reason (e.g. endometriosis, trauma, cancer, etc.), or endocrine disorders (e.g. thyroid or pituitary problems, diabetes). While it may seem disconcerting that this condition is increasing in frequency, the good news is that the increase is largely due to the large number of women who are being treated for cancers and surviving.

    The ovarian failure of POF may be temporary or periodic or incomplete. Some patients may ovulate occasionally so contraception is still necessary if pregnancy is undesired. Pregnancies have occurred after the diagnosis of POF in about one in 12 women not using contraception.

    Menopause means more than just losing your periods. This is a syndrome with clinical symptoms as well as long term consequences. An important distinction here is that women who have had a hysterectomy (surgical removal of the uterus) but whose ovaries function normally won't have periods, but they are not "in menopause." They will go into menopause naturally when their ovaries cease functioning.

    POF is estimated to affect 250,000 American women which represents approximately 3 percent of women between 15-39. The average age of onset is 27. There is no typical menstrual history for women with POF. Approximately 10-15 percent of females with POF have primary amenorrhea, which means they never had a period on their own.

    What are the symptoms of premature menopause?
    Just as with menopause, many women have no symptoms other than that their periods occur less and less frequently, or, in some cases, "irregularly irregular" until they stop altogether. Many women have the typical symptoms of menopause: hot flashes, night sweats, irritability, moodiness, sleep disturbances, vaginal dryness, decreased libido, and hair coarseness/loss.

    What is the difference between "premature menopause" and "perimenopause"? Premature menopause, as explained above, is when a woman enters menopause before age 40, for whatever reason. Perimenopause, on the other hand, is the transitional phase a woman goes into for the 2-10 years preceding her natural menopause. During this time she may have normal or irregular periods and one or many of the symptoms of menopause such as hot flashes, night sweats, mood changes, irritability or sleep disturbances.

    Common myths, misconceptions, and misinformation about early menopause

    The most common misperception is that POF just isn't a big deal. Upon hearing of this condition, many who are not affected react with nonchalance saying "I wish I could get out of having my periods 10 years earlier!" This condition is about much more than losing your periods, however. For starters, this may cause infertility, which can be devastating not only for the woman but her family as well. Even for women who have already had children, this can represent a strong sense of loss. Many women with POF struggle with the emotional burden of feeling "old" before their time. The confusion of the numerous but vague physical and psychological symptoms can be overwhelming, especially when many physicians don't consider menopause as a diagnostic option in women under 40. Some women report that when they asked their doctors if their symptoms could be related to menopause, they are told "Oh you're too young. Come back and see me in 10 years." Patients fear that they are stigmatized; they fear telling others and fear that no one will understand.

    The most dangerous myth is that POF doesn't have any serious consequences other than infertility. This simply is not true. Women with POF go through the same loss of estrogen as menopausal women in their 50s, but usually faster or suddenly, as for women who have surgery to remove their ovaries. In many cases, this estrogen loss is even before these women have had the full benefits of estrogen in their lives, such as building maximal bone mass. Losing estrogen puts women at increased risk for osteoporosis, heart disease, colon cancer, Alzheimer's disease, tooth loss, impaired vision, Parkinson's disease and diabetes. The longer women are without the protection of their own estrogen, the greater their risk for serious health consequences of these conditions.

    Many women in their 20s and 30s whose periods stop for 2-3 months take a home pregnancy test and, if it's negative, assume that their period stopped because of "stress." While this may in fact be true, there are many other potential causes; this is worth discussing with a physician.

    Just because premature ovarian failure is common doesn't mean that it's normal. But just because POF is abnormal doesn't mean the patient is abnormal! POF is a real, legitimate, biologic syndrome that can be treated, and managed. At this point it cannot generally be prevented or cured. The good news is that with prompt intervention and proper management, many of the long-term consequences can be prevented or delayed.

    Your doctor may advise you to keep a diary of your menstrual bleeding: its frequency, duration, amount, and any associated symptoms. This would also note menopausal symptoms such as hot flashes or night sweats. This will help your physician confirm your clinical diagnosis.

    After taking a complete history and doing a complete physical (including an internal exam), there are numerous tests your physician may order to rule out related conditions: this may include a pregnancy test, thyroid and pituitary tests, and tests for autoimmune diseases. The most important test, however, will be an FSH: this is a blood test for the hormone which causes the ovaries to produce estrogen. The higher the FSH, the lower your ovarian function. This should be done at least twice, a month apart. Your doctor may also recommend a blood estradiol level and a karyotype (chromosomal test).

    If you are in menopause, your doctor may recommend other tests such as a bone mass measurement to see if you have osteoporosis. Ask your physician if there are other screening tests usually offered to women in their 50s which you should have earlier since you are menopausal.


    Remember that menopausal women need increased calcium (1,500 mg/day) and Vitamin D, so ask your physician if you should be taking supplements. There are numerous new soy-based food products on the market now targeting menopausal women because of evidence that soy may have an impact on menopausal symptoms. By all means eat them if you enjoy them, and as a good source of dietary protein.

    Stress management

    Since stress is high on the list of consequences of POF, stress management techniques are high on the list of POF management strategies. Lifestyle modifications can also help: get enough rest; exercise, and eat healthfully.

    Support groups

    Women with POF consistently cite the need for more support and understanding of their condition; the POF Support Group ( is a great resource. Founded in 1995, they now have support groups in several cities and are continuing to grow. For POF patients with infertility, there are numerous support groups. And for patients with or at risk for osteoporosis as a result of POF, the National Osteoporosis Foundation (NOF) can be very helpful (

    Whatever your choice of therapy, remember that you're not committed to that choice for life! You and your physician will monitor your progress and your comfort level with your treatment plan. If there are factors that change, including your level of satisfaction discuss this with your physician.

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    Estrogens derived from plants appear to offer many of the benefits provided by hormone replacement therapy (HRT) -- but without the cancer risk associated with estrogen supplements.

    Naturally occurring estrogens, or phytoestrogens, are found in significant amounts in soybeans, cereals, alfalfa sprouts and other plants, according to Drs. Lynette Wroblewski Lissin and John P. Cooke from Stanford University Medical Center in California.

    The authors review the potential benefits of phytoestrogens in the May issue of the Journal of the American College of Cardiology.

    Phytoestrogens have been shown to provide several beneficial cardiovascular effects. Eating a soy-based diet, for example, can lower total cholesterol by 9% and LDL ("bad") cholesterol by 13%, the report indicates. The reductions are even greater for patients with abnormally high cholesterol.

    Phytoestrogens may protect against atherosclerosis by interfering with the initial inflammatory process, the team suggests. Dilation of blood vessels, including the coronary arteries, is also improved in animals treated with phytoestrogens.

    Potential noncardiac benefits of phytoestrogens include a decrease in the number of hot flashes in postmenopausal women, decreased risk of breast cancer and other cancers, and protection against osteoporosis, the investigators note.

    Treatment with phytoestrogens, unlike estrogen replacement therapy, does not appear to increase the risk of blood clots or breast and uterine cancer, according to the report.

    Increasingly, information from a variety of sources supports the increased use of phytoestrogens, especially among individuals with a high risk of developing heart disease. "The current state of knowledge indicates that the world of plant-based estrogens has much to offer," Lissin and Cooke conclude, "but significant questions remain."

    "In the interim," they suggest, "it seems reasonable to recommend that women at high risk of cardiovascular morbidity and mortality, particularly those without a personal or family history of breast or uterine cancer, increase their consumption of foods rich in phytoestrogens such as soy protein."

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