Few physiological processes in life generate so many expectations as menopause. It encompasses a range of changes, from physical and psychological to social and cultural.
Menopause is the process by which the female ovaries cease the hormonal production of estrogen and progesterone, and therefore stop ovulating. Medically speaking, menopause is the absence of the menstrual period for over a year. The onset of menopause occurs around age 50, and the whole process, known as climacteric, can take up to five years.
Menopausal symptoms vary largely and depend, as every change does, on the way you look at the process. You can feel that it is the end of your youth and your reproductive capability, or you can see the change as a new beginning, a new way of experiencing your femininity and a freedom you didn’t have before.
Most symptoms are associated with lack of estrogen. Hot flashes, vaginal dryness, reduced sex drive, and emotional distress are some of the short-term symptoms—lasting from 1 to 5 years after the onset of menopause—that may be experienced. But women going through menopause also face long-term problems like osteoporosis and an increased risk of cardiovascular disease; these can manifest five years after the onset of menopause.
To medicate during menopause is one of the most debated questions in the medical community today.
The tendency in Western medicine is to view menopause more as a disease than a physiologic change, and medication is therefore more common. Whereas, in Eastern medicine, menopause is viewed like a normal physiological process, so a natural approach is more common.
When considering medication during menopause, you must consider the beneficial effects on short-term and long-term symptoms, as well as the negative impact that medication can have on your body. It’s also important to consider other natural alternatives that may help you make a smooth transition.
Hormone Replacement Therapy
There’s been a lot of discussion about hormone replacement therapy (HRP), which has left women with more doubts than clarity. Many women prefer a natural approach while others ask for medications to alleviate their distress.
HRP is based on the supplementation of the decreased or absent estrogen. Short-term symptoms like hot flashes and vaginal dryness, respond adequately to estrogen-replacement therapy within a few weeks of treatment.
Estrogen improves bone mineral density. HRT therefore helps prevent bone loss, decreasing the risk of osteoporosis and hip fractures. The beneficial effect of HRT on bone density is seen even after the treatment is discontinued. This is called “the window of opportunity,” because women may use HRT within five years after menopause with a treatment duration of at least five years, and still be protected from osteoporosis after the age of 60.
The risk of cardiovascular disease in women increases after menopause, but the same concept of “window of opportunity” applies regarding heart disease; women must start treatment before age 60, use it for at least 5 years to still be protected at an elder age.
In every case, the initiation and the duration of treatment must be individualized, as every patient has different conditions and risk factors. It’s important to talk to your doctor before starting treatment of any kind.
Risks and Side Effects of HRT
Risks of HRT are a debated and complex issue. Some mild side effects, like breast tenderness and vaginal bleeding, exist but are easily controlled with medication. Using a low dose of the hormone progesterone along with estrogen therapy, for example, controls bleeding.
Of greater concern are other major side effects:
- Increased risk of uterine cancer: Estrogen replacement therapy is associated with thickening of the endometrium (the inner lining of the uterus), which can lead to endometrial cancer. The risk disappears in women who also take a daily low dose of progesterone.
- Breast cancer: Estrogen replacement therapy, particularly when combined with progesterone, increases the risk of breast cancer. In addition, HRT increases breast density, making breast cancer more difficult to diagnose. The increased risk of breast cancer is seen with estrogen replacement given alone (without progesterone), only in those patients with more than 10 years of treatment.
The North American Menopause Society suggests that “HRT is the most effective treatment for menopausal symptoms at any age, but benefits are more likely to outweigh risks before the age of 60 or within 10 years after menopause.”
The risks and side effects of HRT vary depending on whether estrogen is given alone or in combination with progesterone, it also depends on the patient’s age, age at menopause, dose, duration, and type of estrogen, medical history, and cancer risk factors like family history. The decision on whether or not to take HRT must always be individualized and indicated by your doctor.
Natural Alternatives for Menopause Symptoms
Although there are no clinical long-term studies, a natural approach to menopause can benefit your health even if you’re planning to take HRT.
Diet: To prevent bone loss, you must have an adequate intake of calcium and Vitamin D, as they are the building blocks of healthy bones. In you have a decrease in bone mass or any risk factor for osteoporosis, taking a supplement is the best alternative. Dairy products and dark green leafy vegetables are a good source of calcium.
People who’s protein intake is animal-based, may have a decrease in bone density; a plant-based diet may help you control your symptoms and prevent bone loss.
A healthy, balanced diet based on organic fresh food and decreased sugar intake can make a huge difference in managing your mood changes.
Reduced consumption of caffeine and alcohol: Intake of caffeine and alcohol has been associated with an increase in hot flashes and night sweats. This increase is also seen among smokers.
Exercise: Regular physical activity is crucial for women facing menopause. Some benefits of exercising are that it reduces the risk for breast cancer, strengthens your muscles thus protecting your bones, prevents weight gain, reduces the risk of other diseases, and boosts your mood.
Natural estrogens: The so-called phytoestrogens are naturally occurring plant compounds that are structurally and/or functionally similar to women’s estrogen. They may act as mild estrogens in the body, producing symptom relief, but there is still controversy on their side effects.
Phytoestrogens can be found in soy products, legumes like lentils and chickpeas, flaxseeds, other seeds like sesame, sunflower, and almonds, whole grains, and some fruits like apples and cherries. Increasing your intake of these foods can help you decrease your symptoms.
Menopause is a time of physical and emotional change, but it doesn’t have to be a struggle, and it is not a disease. Seeing change as an opportunity to evolve and grow helps you make a smooth transition through menopause.
The best approach is to get well informed of the changes, possible symptoms, treatment options, and risk factors, so you can choose the best option for you. Always consult your doctor first as she can guide you through the process.
*Editor’s Note: The information in this article is intended for your educational use only; does not necessarily reflect the opinions of the Chopra Center's Mind-Body Medical Group; and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health providers with any questions you may have regarding a medical condition and before undertaking any diet, supplement, fitness, or other health program.