Managing Menopause

Information about the best way to "deal with" the physical transition known as menopause resembles a ping pong game: Take hormone replacement therapy and avoid spongy bones. No, don't take synthetic hormones, they'll up your chances of getting breast cancer. Yes, take the hormones, they'll prevent heart disease. No, don't take them. They're artificial and defy nature -- women weren't meant to be flowing with hormones once they've reached menopause.And don't think the disagreement is just among information gatherers. The information producers themselves are at odds over this one. This past June the New Yorker was the scene of some healthy sparring between writer Malcolm Gladwell and Dr. Susan Love, author of Dr. Susan Love's Breast Book (1990) and Dr. Susan Love's Hormone Book (1997). Gladwell maintained Hormone Replacement Therapy (HRT) was invaluable for women because it lowers the risk of heart disease and osteoporosis, while Love opposes estrogen therapy for the overall population of menopausal women. Love says HRT is too often being used to prevent conditions that don't yet -- and may never -- exist, and she's mostly concerned that HRT can increase a women's chance of developing breast cancer.Unfortunately, the opponents' micro-focus on data interpretation prevented any discussion of existing options to HRT that would allow women to avoid heart disease and brittle bones without having to open themselves to a higher risk of breast cancer. Good thing, then, that Eugene is home to a number of health practitioners who are well-versed in methods of treating menopause symptoms without reverting to synthetic hormones."Menopause is not a disease," says Liz Dickey, a Eugene naturopathic physician. "It's a natural life event." As such, it should be treated with lifestyle and nutritional practices designed to mitigate irritating menopause symptoms. Specific menopause symptoms do respond to uninvasive approaches, Dickey says. Hot flashes, for instance, can be eased with exercise, vitamin E, vitamin C and the citrus bioflavenoid hesperidin, which is contained in the white pith just beneath the rind of citrus fruits. Women can also avoid hot flashes, she says, by reducing the consumption of meat, alcohol, sugar, refined carbohydrates and hot drinks.Sleeplessness is often the first sign of approaching menopause, says Dickey. She recommends easing insomnia through stress management techniques, including exercise, nutrition, meditation or biofeedback, reducing self-imposed expectations and developing a support group.Changes in the skin, Dickey says, can be addressed first of all by drinking plenty of water. Exercise and massage are helpful, as is vitamin C. Women can counter temporary psychological changes such as depression, irritability and problems with concentration by decreasing their intake of sugar, simple carbohydrates, alcohol and caffeine and, again, upping consumption of C, E and B vitamins. In addition, says Dickey, the alternative modality known as homeopathy is "a wonderful resource" for addressing these kinds of symptoms. "But you need to have the right remedy," she says.Jan Stafl is a local physician who has received some reknown for espousing the use of complementary (or alternative) therapies. A member of the Holistic Medical Association, Stafl says that the best medical care combines the best of allopathic medicine -- treatment for acute and traumatic conditions and diagnostic expertise -- with the best of the complementary modalities, such as nutrition, acupuncture, herbs and bio-feedback exercises.For instance, to help protect against breast cancer and to moderate menopausal symptoms, he recommends that women should eat two ounces of soy protein powder daily and some flaxseed, because both contain natural estrogens, or phylloestrogens, that help balance the body's estrogen system. Like Dickey, he also suggests daily doses of vitatmin C, E and betacarotene. Because synthetic chemicals used in insecticides and pesticides can upset the body's internal estrogen system, he recommends avoiding foods "high on the food chain" such as meat and processed foods.To alleviate specific menopause symptoms, he recommends using standard extracts of the herbs black cohosh, the Chinese herb dong quai (angelica), vitex (chaste tree berry) and licorice. Some of these remedies are relatively unknown in the U.S., but widely used elsewhere. For instance, black cohosh -- under the trade name Remisemin -- has been studied extensively in Germany and has been found to be effective in easing hot flashes and insomnia as well as anxiety, depression and nervousness associated with menopause.Although good for symptom relief, says Stafl, these herbs do not protect against heart disease, osteoporosis or Alzheimer's, as does HRT. Stafl suggests that women ascertain their own risk for these conditions by examining their family histories and having appropriate tests done. (Bone scan tests are now available, he says, that cost only about $40.) He agrees with Dickey that diet and exercise can help bolster the body against both osteoporosis and heart disease.Stafl says that women should be well-versed in both the pros and cons of HRT. Prolonged use of HRT -- 15 years or more -- does increase a woman's risk for breast cancer, he says, but short-term use does not.He also believes women should understand the differences between synthetic and natural hormones. A woman's natural estrogen is made up of three different estrogens -- estrodial, estrone and estriol. The hormone provided by the synthetic estrogen Premarin, the one most widely used in HRT, contains 13 different estrogens. Stafl believes natural forms of estrogen -- such as patches, which use estrodial -- are as effective, but safer, than the synthetic variety.Progesterone, another female hormone, is often prescribed for menopausal women along with synthetic estrogen to help prevent cancer of the uterus. But about 30 percent of women who take synthetic progesterone, he says, experience adverse, PMS-like side effects such as anxiety and rage. Synthetic progesterone, he says, doesn't produce those side effects, but is only available through pharmacies known as compounding pharmacies, which pack their own capsules as well as make products such as natural progesterone and progesterone oil. Eugene already has one such pharmacy -- Baker's Pharmacy on 1200 Hilyard St. In early November another compounding pharmacy, Broadway Apothecary, will open on 160 E. Broadway. In short, says Stafl, when it comes to making decisions about menopause symptoms and hormone therapy, "There are no cookie cutter approaches. A woman needs to listen to the wisdom of her body, and make her own, individual choices."

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