What is the best way to handle menopause? Ask that question of 10 people and chances are each answer will be different. But there is one fact about menopause that holds true for all: Each woman’s experience with it will be unique.
There are a myriad of choices to deal with the issues that can come along with menopause. With hormone replacement therapy, alternative medicine, herbal supplements and everything in between, all with benefits and risks, how does a woman determine what course to take?
“Everyone is unique. My advice is to seek advice. See what a gynecologist has to offer. Bio-identical hormones and estrogen can be helpful. However, it is also important that you have someone on your team that knows the alternatives and offers help for the whole person,” said Wendy Pollock, a doctor of chiropractic and certified classical homeopath at Inner Shores in Portland. “Menopause is a great time to consult with a health practitioner that can maximize your strengths and help build skills for coping with this time of life.”
According to the website Womenshealth.gov, during menopause, the body produces less of the hormones estrogen and progesterone, which can cause night sweats, hot flashes, vaginal dryness and bone thinning. As hormones fluctuate, women may also experience mood swings and issues with sleeping and memory.
For Masina Wright, a naturopathic doctor who practices integrated medicine at the Age Management Center in Portland, addressing health during the menopausal transition is more than just symptomatic relief of things like hot flashes.
“This is a key time to address stress, cortisol, inflammation, insulin resistance and other metabolic markers before they settle into actual chronic disease,” said Wright. “The five major ‘side effects’ of estrogen, progesterone and testosterone deficiency are hot flashes, mood changes, vaginal dryness/libido changes, sleep disturbance and memory loss. These can all be improved by estrogen or estrogenic receptor supportive herbs alone. However, most of these symptoms are rooted in more than just hormone deficiency, so true relief and long-term improvement comes from using a fully integrative and individualized approach.”
Considering the person as a whole is also important to Pollock.
“When I see a patient I look at the big picture, not just at symptoms,” said Pollock. “I will look at all of the issues a woman might be having with menopause. Listening to the individual and prescribing the course of action unique for them is important.”
One path women may choose is that of hormone replacement therapy. According to the U.S. Food and Drug Administration’s Office of Women’s Health, different types of hormonal therapies, including estrogen or progestin-only medicines, a combination of estrogen and progestin, or a combination of estrogen and other medicines used during and after menopause can help to alleviate symptoms.
But hormone replacement can also carry risks for some women, which may include heart attack or stroke, blood clots, breast cancer, dementia (in women 65-plus), gallbladder disease or high triglyceride levels, high blood pressure and allergic reactions to the medication itself.
Bio-identical forms of hormones (estrogen and progesterone) offer an alternative. According to a report by Harvard Medical School, the hormones are identical in molecular structure and act like the hormones women make in their bodies. Bio-identicals are synthesized from a plant chemical extracted from yams and soy. But bio-identicals also have risks, as do other forms of treatment for menopause.
“I am a specialist in integrative bio-identical hormone use,” said Wright. “There are some risks to hormone replacement. The risks of synthetic hormones are much higher than the risks of bio-identical hormones. However, all hormone use can carry some risk. The biggest fear out there is the risk of breast cancer. This has proven to be a very low risk when bio-identical estrogen and progesterone are used together by a prescribing professional well trained in hormone use and risk analysis.”
For Wright, a key first step hormone replacement therapy for women still in reproductive years to consider is testosterone, which, she said, has been used as a stand-alone treatment for menopause since 1937.
“Testosterone is the feel good, feel strong, feel smart, feel sexy, let’s go work out hormone, but gets very little attention or press as a viable alternative or complement to estrogen and progesterone treatments,” said Wright. “Progesterone starts to decline in the mid-40s and then estrogen loss is the final herald of ‘the change.’”
Wright said it is important to her to assess each patient for risks and benefits of hormone treatments, including “extensive lab work to evaluate metabolic health, and then the patient and I make educated decisions together about hormone care.”
Not addressing menopause at all can cause issues, too, Wright said.
“Bone loss, loss of cardiovascular and brain elasticity, accelerated aging and vaginal atrophy are a few risks of unattended menopause,” she said.
Some women are looking for more “natural” methods, which can be tricky to define, according to Wright.
“From my perspective, a ‘natural’ approach to menopause is one that is fitting with an individual woman’s health needs. For example, for one woman that may be a complete panel of bio-identical hormone replacement treatment (natural) plus nutraceuticals, herbs, and stress management. For another, a natural approach could be to only take bio-identical testosterone and work on heart health with nutrition and exercise, and for another, natural may mean not using any supplements or hormones at all, and just focusing on lifestyle counseling and sleep hygiene,” said Wright. “Natural is such a broad term these days, but it can include any non-synthetic approach.”
The use of botanical medicine or herbal remedies is another approach, which, Wright said, poses few risks, although there can be herb-drug interactions and allergic responses to herbs. The risks of other therapies, such as acupuncture and stress management, exercise and meditation practices, are also low.
Diet is important to consider at any stage of life, but even more so during menopause.
“Sugar and refined carbs can really affect health. I recommend that women look at their diet before thinking of supplements, and that they eat lots of vegetables and fruits and lean protein,” said Pollock.
Wright said other factors to consider during menopause are adrenal health, stress, digestion and thyroid health. Pollock also encourages women to think about where they are at in their life and whether they need to make adjustments.
“Women may be experiencing empty nest or a midlife crisis and may need a better balance in their life,” said Pollock. “Menopause offers a chance for nurturing yourself as you enter a new phase. Some practices to help find balance in life, like practicing mindfulness or yoga, can be far more beneficial than medical or supplemental therapies.”
Determining what course to take is up to the individual. What works for one may not work for another. That’s why it is so important to find a health-care professional that will listen to and work with the individual, Pollock said.
“Menopause is complex. You need to look at everything,” said Pollock. “It’s good to have someone help guide you as a mentor, someone that can step back and see the whole person.”
“The one thing I recommend is seeing a naturopathic doctor or integrative medicine professional,” said Wright, “and taking this time to take care of your health, whatever that means for you.”