Women of a Certain Age By Lorrie Klosterman May, 2005 CHRONOGRAM
I recently sat listening to an explanation of how geothermal heating and cooling systems work, periodically wandering off into thoughts of how my meteoric temperature changes, as a "woman of a certain age," might be harnessed for renewable energy.
As a woman, waving goodbye to one's reproductive years has its pros and cons. Who could miss the monthly caretaking required of the fertile years, the water weight gain, PMS, cramps, unwanted pregnancy scares (or realities), contraception, unexpected need for hand-washing of lingerie? Always entertaining and full of surprises, though, the female body transitioning through menopause offers a whole new set of challenges.
Until recently, talking about the "change of life" publicly was unheard of. Tamara, moderator of the menopause chat board on Susun Weed's website, says as she enters menopause at 47, "It was almost taboo to talk about it back when I was growing up, kind of like childbirth and pregnancy." Now, that's all changing. Women are helping each other with ideas, support, and, above all, truth about what it's really like. It's great for men to know about this too.
Strictly speaking, menopause refers to the point in a woman's life, somewhere in her forties to early fifties, when she has her last menstrual period (or when they end abruptly due to surgical ovariectomy, chemotherapy, or radiation). For months or a few years before that ovarian output of estrogens and progesterone declines, and concomitant menstrual cycles becomes irregular. That transitional phase is often called premenopause, though perimenopause or "the climacteric" are more appropriate terms. A woman is considered postmenopausal when no menstruation has occurred for 12 consecutive months.
Power Surges Plus
For the majority of women (60-80 percent in the US), reproductive fertility doesn't end with a whimper, but with dramatic fluctuations in skin temperature caused by blood vessel dilation—so-called hot flashes and night sweats, or "power surges," as empowered woman call them. More formally known as vasomotor symptoms, flashes typically last a few minutes, though in rare cases up to an hour, and occur a few or many times an hour, around the clock. Often women know when one is coming by a prescient anxiety, nausea, pressure in the head, or tingling of the skin. If you've never experienced one, you're missing something. A surge of heat starts from somewhere in the chest and spreads to the neck, head, arms, and abdomen, feeling hot enough to melt metal and destroy a gazillion pathogens in a single surge. Indeed, Vicki Noble, author of Shakti Woman a book about feminine power, likens hot flashes to a natural cleansing. Perspiring is common, leaving skin cool and moist, and inducing chills.
Common triggers of a hot flash are certain foods and beverages (hot drinks, alcohol, sugar, spicy foods), warm environments (hot weather, hot tubs and saunas, overheated rooms and vehicles), smoking, and stress. At times they seem triggered by everything, including waking up, eating or drinking anything, shifting positions—stuff that is a little hard to avoid. At their worst, flashes and chills prevent a good night's sleep and cause daytime fatigue, and may generate depression, anxiety, panic attacks, malaise, and emotional explosions.
The perimenopausal years can also bring vaginal dryness, painful intercourse, thinning of skin, weight gain, low energy, and more—though only vasomotor symptoms and vaginal dryness are convincingly related directly to ovarian hormonal changes. The other manifestations may reflect aging in general or society's attitudes toward aging women. Furthermore, secretion patterns of other hormones produced by the pancreas, the thyroid, adrenal, pineal, and pituitary glands are also changing in a woman's 40s and 50s.
wake-up call on hormone replacement
Putting up with menopause's changes is, depending on the woman, tolerable, demanding, disruptive, or absolutely crazy-making. For decades post-menopausal women have been encouraged (to put it mildly) by mainstream medicine and a youthfulness-oriented society to take hormone replacement therapy (HRT), to minimize phsiological or emotional challenges related to menopause. HRT typically consists of Premarin or a similar product (estrogens derived from the urine of pregnant horses), often combined with a progesterone-like hormone (like Provera, medroxyprogesterone), without reasonable evidence that doing so is safe or effective in alleviating the many things for which HRT has been prescribed. And women by the millions have taken it, even though it is approved only for short-term alleviation of vasomotor symptoms, vaginal dryness, and as a preventative—not a treatment—for osteoporosis.
But a few weeks ago, the National Institutes of Health held a three-day conference, "Management of Menopause-Related Symptoms," to reevaluate HRT in light of the Women's Health Initiative, a massive, 15-year observational study of over 161,000 healthy postmenopausal women. That study documented higher rates of blood clots, stroke, heart disease, and breast cancer among women receiving HRT compared to a placebo. There was no evidence for protection of the heart (to the contrary) or of cognitive function, as HRT has been said to confer. Bone fracture rates were lower, but the serious risks make HRT inappropriate as an osteoporosis preventative, except for women at significant risk who cannot take other medications.
"These findings raised serious questions about the safety of estrogen use to treat symptoms of menopause," concluded the conference's panel of experts, further asserting that "Menopause is 'medicalized' in contemporary American society," and "There is great need to develop and disseminate information that emphasizes menopause as a normal, healthy phase of women's lives." Importantly, panel members were chosen to ensure lack of academic or financial bias—they had no pro-drug agenda.
That is very different from the milieu under which estrogen supplementation began, and in which it continues today. Barbara Seaman (Read Power Surge's transcript with Barbara Seaman), veteran activist for the women's health movement and author of four landmark books and many articles on drugs and women's health, recalls, "During the `70s, the people who were pushing these drugs [pharmaceutical companies], with no real science or clinical trials behind them, were the radical ones. We were being conservative about it by being cautious. We only took hormones if desperate because we were aware of how bad the studies were—that they were marketing devices."
Seaman's most recent, highly acclaimed book, The Greatest Experiment Ever Performed on Women chronicles the promotion of estrogen supplementation by the medical/pharmaceutical industry, from the early days of megadose birth control pills, when no information was given to women about life-threatening health risks, to HRT's status as standard therapy today. "Publications of data showing a very high increase in endometrial cancer, which is the most likely risk if taking estrogen supplementation, started in 1947," she says. She and other women formed the National Women's Health Network, whose many successes included getting all women's hormone products labeled with known health risks by 1977. "The sad part not being talked about much is that some of the women who got dependent on [HRT] were those who had not even had hot flashes in the first place, but were put on it as a preventative of osteoporosis or dementia"—things now discredited or not worth the risk for most women.
Alternate Estrogen interventions
HRT prescriptions have dropped since the Women's Health Initiative data started coming out in 2002, but women with debilitating symptoms may still consider it worth the risk. Seaman acknowledges the problem. "My colleagues and I kept screaming that women with hysterectomies and ovaries removed, especially when they were very young, suffered terrible menopause."
There are other approaches to hormonal replacement besides HRT, though they lack safety and efficacy studies. Actress Suzanne Somers' books brought the public's attention to "natural hormone replacement" and laud the benefits of looking and feeling forever young. J. V. Wright, MD, and J. Morgenthaler explain in their own book, Natural Hormone Replacement that a woman's natural circulating estrogens are very different in kind and quantity than what HRT provides. Natural hormone replacement instead mimics the typical proportions of three human estrogens—mostly estriol, with some estradiol and estrone—along with progesterone, DHEA (dihydroepiandrosterone), and testosterone. The only catch is that it's not natural to expose a woman's body to that steroid cocktail after menopause. (Incidentally, the hormones are made in the laboratory from precursor molecules in Mexican wild yam. That's something the human body can't do, so creams and pills containing yam itself are useless.) These estrogens are not available by prescription, but select pharmacists will provide them.
Estrogen (and progesterone) supplements are also available by prescription as transdermal patches, creams, gels, ointments, and sublingual tablets. Vaginal creams help with dryness by stimulating cells locally. Each of these other non-oral delivery approaches introduces estrogen, mostly as estradiol, into the bloodstream at various levels, with unknown long-term health outcomes. Estrogens—especially estradiol—remain highly correlated with endometrial and breast cancers.
There is strong evidence that hot flashes/night sweats and vaginal dryness are associated with the changes in circulating hormones around the time of menopause. But there is either no such correlation, or insufficient data to test for one, with other manifestations like changes in mood, forgetfulness, fatigue, back pain, stiff or painful joints, and urinary incontinence. Whether menopause-related or not, non-pharmaceutical strategies to relieve them are abundant.
Susun Weed (Read Power Surge's transcript with Susan Weed), Woodstock resident and nationally renowned herbalist, is a guiding spirit for women seeking options outside mainstream indoctrination. Her Wise Woman approach to menopause starts with great nutritional habits before menopause to build strong bones and healthy tissues, and different nutritional goals for the height of menopausal transition (the climactic) and postmenopause. Too abundant to cover here fully, the highlights include seeking foods rich in B vitamins, vitamins C and E, calcium, magnesium, and potassium, and turning to a host of herbal allies.
Weed recommends taking preparations of horsetail, oatstraw, red clover blossom, stinging nettle, and seaweeds. "These gentle green allies are more like foods than drugs," she says, and can be purchased from health food stores or herbalists, or harvested in the wild or grown locally (except for seaweeds). Other women rave about the benefits of motherwort, sage, dong quai, black (not blue!) cohosh, primrose, and a few others. Not all of them work for everyone, and some may work at some phases and not others. Scientific studies on these are few, so the key is experimentation, one herb at a time. Seek specific usage instructions from reputable sources such as Weed's books, workshops, or website (www.susunweed.com), or other respected books, naturopaths, or herbalists.
The fact that Asian women on traditional diets have less incidence of menopausal discomfort spurred the idea of augmenting American women's diets with soy products. Indeed, soy and other legumes (and red clover) contain phytoestrogens or isoflavinoids ("plant estrogens") that may moderate menopausal symptoms. But concern is growing that soy products are harmful because of the phytic acid, trypsin inhibitors, and hemaglutinin they contain, unless they are fermented (e.g., miso, tempeh). Susun Weed says red clover provides all the benefits of soy.
Dr. Sam Schikowitz, a naturopathic doctor in New Paltz, has had the best success in treating menopausal manifestations with Chinese herbs. "Western herbalism is very well researched, but as a system, Chinese medicine has so much more history and experience around it. The real gem of Chinese medicine is the diagnostic part. There are core formulas that have evolved for various presentations, and then I modify them for each person specifically. People see incredible improvement in hot flashes and night sweats with very simple regimens. I use a combination of Chinese herbal formulas and some naturopathic approaches if there are additional symptoms like mood changes or weight gain." He also emphasizes attending to bone health before menopause, with preventative supplements of vitamin D, calcium, magnesium, and the trace minerals boron and strontium.
There is also the strategy of riding with the changes with behavioral, perceptual, and spiritual support. Tamara finds comfort in simple and varied things. "I like to use handheld fans, take walks in nature, and appreciate yoga and tai chi. I would recommend getting rid of stressful things in your life, or at least plan time doing something you really enjoy away from people. I have a greenhouse I work in, a peaceful sanctuary." Other coping mechanisms include dressing in natural-fiber clothing and in layers; always keeping a water bottle handy; sleeping in a cool room, but with extra covers nearby for chills; and having a private bed to retreat to.
Go online and you can tap into Power Surge, a decade-old and highly lauded support phenomenon (www.power-surge.net) founded by Alice Lotto Stamm to fill a chasm in women's access to unbiased information. (She also coined the term "power surge" to replace "hot flash," tainted with pejorative connotations.) "The time had finally come for menopause discussions to be taken from the closet into the living room for intelligent discourse," her site explains, and it offers everything imaginable regarding the physiological, emotional, psychological, and spiritual challenges of menopause. It doesn't promote any specific treatment, acknowledging that each woman and her needs are different.
What Stamm does assert is this welcome message: "We need to dispel the myth that after women go through menopause, they are no longer the desirable, feminine, sexual, and beautiful women they were before."
Indeed, thousands, perhaps millions, of women are turning to the practical, philosophical, and spiritual treasures of menopause that got lost somewhere in modern times. Through books, online and paper-published articles, and workshops, Weed and many others are extending the path cleared by Seaman and the Women's Health Network, reforging an empowering framework for women's post-reproductive years.