Menopause - problems and how to tackle them

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The menopause is a natural process that results when the ovaries run out of eggs. It is possible to predict when this will happen by measuring antimullerian hormone, inhibin B and FSH.

The ovaries normally produce the sex hormones oestrogen (of which there are three) and progesterone. The menopause is said to have happened when one year has elapsed without seeing a period. The average age at which this occurs is 49, but the age of onset of menopause runs quite strongly in the family, so when your mother went through the menopause will give a clue.

As the ovaries run out of eggs, the pituitary senses this and sends out hormones to try to kick them into action. Measurement of these hormones [follicle stimulating hormone (FSH) and lutenising hormone (LH)] is the basis of tests to diagnose the menopause. However, the ovaries do not run out of eggs in a smooth way - sometimes they get a "second wind" after a few months of missed periods to release another egg and another menstrual cycle so that FSH and LH come back to normal for a short while. In other words, do not rely too heavily on high levels of FSH and LH to diagnose the menopause!

After the ovaries have failed, there are still some sex hormones made in the adrenal glands and body fat.

I always think that there is an evolutionary explanation for everything! My view is that the menopause is necessary to allow the woman to raise her own children to an age at which they become independent (and help her children raise their children) without having the burden of more babies coming along!

The menopause may also occur to protect the woman from her own hormones. Oestrogen and progesterone are both growth promoters and therefore risk factors for cancer. The reason why men do not get breast cancer as often as women is not because they don't have breasts (they do!) but because they don't have so many female sex hormones.

The problems and symptoms of the menopause occur because of falling levels of oestrogen and progesterone. There are many symptoms which are ascribed to the menopause. However, the only symptoms which have been clearly linked with the menopause are the hot flush and dry vagina. This is an important point because it means that should other symptoms arise at this time of life, they should not be put down to the menopause. This is because the gut reaction for many doctors and indeed patients is to prescribe HRT when there are many other much safer environmental treatments available such as correcting nutritional deficiencies, identifying food allergies, correcting thyroid problems and disturbed sleep.

Even when HRT is used, it only postpones the symptoms of the menopause - it is the declining levels of oestrogen and progesterone which cause problems.

Management of the menopause

I'm coming to the view that as we age we acquire "metabolic dyslexias". That is to say that we get less good at making certain key molecules. Some of these molecules, such as melatonin, DHEA, D-ribose and Co Q 10, I am fairly sure about; but there are bound to be others. As we age, our metabolism becomes less efficient and therefore we need more raw materials in order to produce the essential molecules. This means we have to work even harder at the general approach to health, and now is the time to review diet and lifestyle!!

Wobbly Hormone Levels

The major symptom of the menopause which is a nuisance by day and can disturb sleep by night is hot flushes and sweating. This is probably caused by what I call wobbly hormone levels and explains why some of the herbal remedies are helpful. Herbal remedies such as Black Cohosh (up to 2400mgs daily), Agnus Castus (20mgs daily), Red Clover, Wild Yam and so on, are partial agonists. In pharmacology, an agonist is a drug that has an affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances, such as female sex hormones. A partial agonist is a compound which has an affinity for a cell receptor, but unlike a full agonist, will elicit only a small degree of the pharmacological response peculiar to the nature of the receptor involved, even if a high proportion of receptors are occupied by the compound. This means that when hormone levels are high, partial agonists occupy relevant cell receptors and block the effects of the hormones. Conversely, when hormone levels are low, then these partial agonists still occupy hormone receptors but produce mild agonist activity. The idea here is that we iron out and flatten some of the wobbles. This can be very helpful in preventing hot flushes.

Having said that I am increasingly coming to the view that many hot flushes are triggered by hypoglycaemia. The clue here is that diabetics, who don't control their blood sugar levels very well, often flush with alcohol. Alcohol is extremely good at destabilising blood sugar levels and the diabetic flush is very similar clinically to the menopausal flush. So, work hard on doing a Stone Age Diet, which is of low glycaemic index. More often I now prescribe the ketogenic diet - please see Ketogenic diet - the practical details and My book The PK Cookbook - Go Paleo-ketogenic and get the best of both worlds. There are also nutritional supplements which can be taken to stabilise blood sugar level Hypoglycaemia.

What happens if you have a late period?

As hormone levels decline, the periods may become irregular, heavier or lighter. So long as the "pattern" of the period is the same (i.e. heavier on the first day or two, then lighter for the next few days), then I am happy to think this is a normal period. However, if there is irregular vaginal bleeding (i.e. dribs and drabs, not related to a period), or any bleed for more than one year after a period, then this should be fully investigated by a gynaecologist. See Vaginal bleeding

Hormone Replacement Therapy (HRT)

My view is that there is now no good clinical reason for starting a woman on HRT. Indeed the Million Women HRT Study had to be stopped early because the excessive number of cancers in the hormone taking group. (Please see Breast cancer and hormone replacement therapy in the Million Women Study ) As a result world prescriptions of HRT fell by 75%. Progesterone has now been classified as a class one carcinogen by the World Health Organisation. This applies to progesterone whether they are synthetic, natural, given by pill or patch. Progesterones and oestrogens are addictive, which is why it can be very difficult for some women to stop their prescriptions, but applying the above interventions eases withdrawal symptoms.

Prevention of Cancer

See also Cancer - the principles of prevention and treatment

Female cancers

The greatest worry when using sex hormones is the long term risk of cancer. Oestrogens are converted in the body to different oestrogens, some "good", such as 2-hydroxyestrone, some "bad", such as 16-alpha-hydroxyestrone. The enzyme which controls this balance is inhibited by a natural substance indole-3-carbinol found in cabbage and all brassicas. Indeed, a study by Dr Marie Bell demonstrated complete regression of cervical cancer in over 40% of women simply as a result of taking indole-3-carbinol. This ration of 2/16-alpha-hydroxyestrone is critical and improved by eating cabbage. So the message is, if you want to prevent breast, cervical and womb cancer, eat up your cabbage!

Prostate Cancer

It has long been thought that testosterone is the cause of prostate cancer. But this does not really make sense since it is the older men with declining levels of testosterone who get prostate cancer. It appears to be abnormal metabolism of testosterone which is the cause of the problem. As men age, their metabolism goes awry and a disproportionate amount of testosterone is metabolised (by an enzyme aromatase) to oestrone and oestradiol. It is these female hormones which are the culprits in prostate cancer.

Therefore, it is important to monitor levels of not just testosterone but also oestrogens in men on testosterone. If the oestrogens are raised, then the offending enzyme aromatase can be inhibited by crysonine (a natural constituent of passion flower) 4 capsules of 500 mg daily. Furthermore, there is evidence to suggest that, as with oestrogens and female cancers, men also have "good" and "bad" oestrogens and the 2/16-alpha-hydroxyestrone ratio is also important. As stated above, the ratio can be improved by eating cabbage and other brassicas - so keep chewing!

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