Menopause

For decades, mainstream medicine viewed menopause as an illness, something that required professional treatment. But over the past 20 years, that perception has gradually changed, as women have learned more about their bodies and their health and have demanded that their physicians do the same. Today, women have reclaimed menopause as an occasion to celebrate, a rite of passage into maturity and wisdom.

Today, more than 40 million American women are at or past menopause. This is unprecedented in human history. At the turn of the twentieth century, the average life expectancy for women was just 48 years, so relatively few got to experience life after menopause. Today, the average life expectancy for women is about 80 years. Considering that most women enter menopause around age 50, they are postmenopausal for more than one-third of their lives.

Of course, not every woman experiences menopause in the same way. Some breeze through "the change" with nary a hot flash. For others, the discomforts are so severe that they're intolerable.

Most women realize that they're going through menopause when they stop having their periods or they start experiencing hot flashes and other common discomforts. In fact, menopause is a long, slow process that begins while you're in your late thirties. Even though you're still menstruating, your ovaries are producing less estrogen. In your early forties, you may develop some menstrual irregularities; after age 45, you may experience mild hot flashes and vaginal dryness. These symptoms become more noticeable as you approach age 50.

Between ages 45 and 55, your periods become even more irregular. They may come more frequently, or they may not come at all. They may last longer or be heavier than normal. You may have spotting between periods.

As your menstrual cycles come to an end, ovulation becomes sporadic but may still occur. "If you don't want to get pregnant, you should keep using contraception for several months after your last period," advises Anne Simons, M.D.

Among women who enter menopause naturally, some 20 percent notice no changes other than a gradual cessation of menstruation. About 50 percent experience mild discomforts. For the remaining 30 percent, menopause brings on severe physical and emotional symptoms. The most bother­some symptoms include the following:

Hot flashes. These sudden feelings of warmth come on without warning and last from 30 seconds to 5 minutes. Your face, neck, and chest may become flushed. You may perspire considerably and experience heart palpitations.

Vaginal dryness. As estrogen production declines, the mucous membrane that lines the vagina begins to thin. As a result, there is less vaginal lubrication. This can lead to itching, irritation, and discomfort during intercourse.

Emotional distress. During menopause, some women experience bouts of depression, nervousness, and irritability. These emotional upsets are most common among those who have personal histories of premenstrual syndrome or postpartum depression. All of these conditions are associated with cyclical hormonal changes, says Christiane Northrup, M.D., founder of the Women to Women health center in Yarmouth, Maine, and past president of the American Holistic Medical Association.

To minimize your menopausal symptoms, you have a number of conventional and alternative measures at your disposal. Here's what the experts say can help.

Nutrition

Savor soy foods. In China and Japan, few women experience hot flashes. The reason: Their traditional diet is rich in soy foods, especially tofu. Soy contains plant estrogens, which have properties similar to human estrogen. Several studies have shown that phytoestrogens may help relieve hot flashes, just like hormone-replacement therapy (HRT).

Stephen Holt, M.D., professor of medicine at Seton Hall University in South Orange, New Jersey, suggests consuming 50 to 100 milligrams of soy isoflavones a day. You can get this amount by consuming 2 to 4 ounces of tofu, 1 ounce of soy-based textured vegetable protein, 2 to 4 cups of soy milk, or 6 to 12 tablespoons of roasted soy nuts.

Become partial to plant foods. Women who are vegetarians seem to glide through menopause with little discomfort, observes Andrew T. Well, M.D., director of the program in integrative medicine at the University of Arizona College of Medicine in Tucson. A vegetarian diet emphasizes plant-derived foods, many of which contain phytoestrogens. Besides soy, good sources of phytoestrogens include apples, carrots, green beans, chickpeas, wheat, oats, corn, peanuts, cashews, and almonds.

Sip your way through the day. By keeping yourself well-hydrated, you help maintain natural vaginal lubrication. So drink plenty of water and juices throughout the day, Dr. Well advises. "Plenty" means at least eight 8-ounce glasses of fluids.

Supplements

Ease discomfort with E. Studies dating back to the 1940s show that vitamin E helps relieve menopausal symptoms. "I've had excellent results using vitamin E to treat hot flashes," says clinical nutritionist Shari Lieberman, Ph.D. The vitamin also helps prevent vaginal dryness in about half of women who take it, Dr. Well says. And it may help reduce your risk of heart disease, the leading cause of death among postmenopausal women.

Both Dr. Lieberman and Dr. Well recommend taking 800 international units (IU) of vitamin E a day. But check with your doctor first since doses over 400 IU a day should only be taken under a doctor's supervision.

Exercise

Stay one step ahead of symptoms. According to Dr. Weil, exercise is beneficial because it builds muscle. Muscle cells contain an enzyme called aromatase that can produce estrogen from other sex hormones. In this way, exercise acts as a natural form of HRT.

Most experts recommend getting at least 30 minutes of physical activity every day. But you don't have to sweat much to reap the benefits. According to Susan M. Lark, M.D., director of the PMS and Menopause Self-Help Center in Los Altos, California, the gentle stretches and postures of yoga are just as effective as more strenuous workouts.

Relaxation Therapies

Calm down to cool off. Several studies have shown that deep relaxation can take the heat out of hot flashes. No matter which relaxation technique you prefer, you get the best results with daily practice. Thirty minutes a day is ideal, but even 10 minutes a day helps, says Tori Hudson, N.D., professor of gynecology at the National College of Naturopathic Medicine in Portland, Oregon.

Herbal Medicine

Turn to black cohosh. Black cohosh has a long history as a treatment for gynecological complaints. Scientists have determined that the herb works because it contains plant estrogens.

In Germany, women use a black cohosh preparation called Remifemin. Dr. Northrup prefers Remifemin to black cohosh tincture because it's a standardized extract. "Numerous clinical trials have shown that Remifemin compares very favorably with conventional HRT," she says. "Black cohosh decreases hot flashes, vaginal dryness, and depression as effectively as conventional hormones but without the side effects."

In the United States, a growing number of health food stores sell Remifemin. If you're able to find it, use it according to the package directions. Otherwise, look for a standardized black cohosh extract. Take two capsules of the extract a day, advises Christopher Hobbs, L.Ac., an herbalist in Santa Cruz, California, and the author of several authoritative herb guides.

Try an herbal trio. For hot flashes and other menopausal symptoms, Dr. Well recommends a combination of dang gui (Chinese angelica), chasteberry, and damiana. "Dang gui balances female hormones," he says. "Chasteberry helps regulate estrogen and progesterone production. And damiana is a female tonic."

Look for these herbs in tincture form. To use the tinctures, add one dropperful of each to a glass of water or juice. Drink the mixture at midday every day until your symptoms subside, Dr. Weil says. Then gradually taper off the herbs.

Home Remedies

Defeat hot flashes by degrees. If you're bothered by hot flashes, take steps to keep yourself and your environment cool. Dress in layers of loose, lightweight, naturalfabric clothing that you can take off easily, Dr. Simons suggests. Then when a hot flash strikes, remove the outer layer. At night, wear lightweight pajamas and use light­weight blankets and bedspreads. If possible, set the thermostats in your home and office at or below 68°E Otherwise, run fans.

Watch what you're drinking. According to Dr. Simons, caffeinated and alcoholic beverages seem to trigger hot flashes in some women. In addition, caffeine and alcohol are diuretics. By depleting your body of water, they may contribute to vaginal dryness.

If you smoke, quit. One study showed that compared with women who don't smoke, those who smoke have more frequent and more severe hot flashes.

Enjoy intercourse. One study examined the relationship between women's sexual activity and the thickness of their vaginal mucous membranes. The more women had sex, the thicker their membranes became.

How does sex help? "Sensitive love­making and regular orgasm improve blood flow to vaginal tissues," Dr. Lark says.

Lubricate before lovemaking. If you're experiencing vaginal dryness, sex may be the last thing on your mind. The lack of lubrication makes intercourse painful. But it doesn't have to be that way, says sex and marital therapist Louanne Cole-Weston, Ph.D., of Sacramento, California. She suggests trying a commercial water-based lubricant or even a little olive oil. Don't use petroleum-based products such as Vaseline, she cautions. They are difficult to wash out of the vagina.

Other God Choices

Homeopathy

Ask for homeopathic help. Homeopaths prescribe several medicines for menopausal discomforts, says homeopath Dana Ullman. Among the most popular are Lachesis, Natrum muriaticum, and Sepia. Which of these works best for you depends on your individual symptoms. For a recommendation, consult a homeopath.

Chinese Medicine

Strengthen your Kidney. Practitioners of Chinese medicine attribute menopause to a decline in Kidney qi, says Efrem Korngold, O.M.D., L.Ac. "You treat menopause by strengthening the Kidney;' he explains.

For this purpose, he prescribes several herbal preparations. One formula, called Zhi Bai Ba Wei Wan, contains rehmannia root, peony root, philodendron bark, and several other herbs. Another formula, called Da Bu Yin Wan, is made with rehmannia root, philodendron bark, and tortoise shell.

Let your fingers provide relief. Acupressure can help ease menopausal symptoms. Michael Reed Gach, founder and director of the Acupressure Institute, suggests applying steady, penetrating finger pressure to each of the following points for 3 minutes.

• Heart 7, located on the pinkie side of the wrist crease that's closest to your palm
• Kidney 3, located in the hollow between your Achilles tendon and the inside of your anklebone
• Spleen 6, located four finger-widths above your inner anklebone on the back inner border of your shinbone
• Extra Point Yin Tang, located just above the bridge of your nose, exactly between your eyebrows

If acupressure doesn't seem to improve your symptoms, consider consulting a trained acupuncturist for treatment. Sometimes professional needle stimulation works when finger pressure doesn't.

If you're premature, count on Chinese cures. Women who receive radiation or chemotherapy for cancer often become menopausal prematurely-as early as their late thirties. For women who want children, this poses a big problem. Premature menopause also increases a woman's risk of heart disease and osteoporosis.

If you're to be treated for cancer, you may want to ask your doctor about using Chinese medicine in conjunction with radiation or chemotherapy. "In my experience, a course of acupuncture and Chinese herbs administered at the same time as radiation or chemo can often prevent premature menopause," Dr. Northrup says. "It can also alleviate many side effects of cancer treatment:"

Ayurvedic Medicine

See about saffron. Ayurvedic physicians view menopause as primarily a Vata condition, says David Frawley, O.M.D. He prescribes anti-Vata herbs that support the reproductive system, such as saffron, shatavari, kapikacchu, and ashwagandha.

Hot flashes, on the other hand, are more of a Pitta condition. They respond to treatment with saffron and shatavari.

Medical Measures

Among mainstream M.D:s, the treatment of choice for menopausal symptoms is HRT. A typical regimen consists of daily doses of estrogen in the form of Premarin, along with extra progesterone. (faking estrogen without progesterone substantially increases the risk of uterine endometrial cancer.)

HRT is controversial. Whether or not it's appropriate for you depends on your individual medical situation. Discuss the benefits and risks with your doctor. Together, the two of you can decide if HRT is right for you.