Some women have a miserable time at menopause. Others barely notice that it’s happening. Either way, as the century turns, more women all over the world will go through “the change” than at any other time in history.
Menopause is not really a single event but rather a process that can last a decade or longer. The average woman has her last period between the ages of 48 and 52, but menopausal changes actually begin much earlier. Women often notice changes in their cycles when they’re in their early forties or even before then. Periods may be shorter or longer, lighter or heavier; they may come closer together or farther apart.
The Estrogen Connection
It’s during this time, known as perimenopause, that the ovaries gradually slow their production of the female hormone estrogen and that a woman begins to notice the effects this has on her body. So why do some women experience such discomfort at menopause, while others never have so much as a single hot flash?
It may be because some women experience more drastic drops in their estrogen levels than others do, says Margo Woods, D.Sc., associate professor of community health at Tufts University School of Medicine in Boston. Dr. Woods is doing research on the effects of soy on menopausal symptoms. Asian women, who have lower estrogen levels before menopause than Western women, experience less drastic drops in estrogen, which may be one reason that they report fewer menopausal symptoms, says Dr. Woods. Many researchers feel that diet may influence menopausal symptoms.
And some lucky women, about 25 to 30 percent, don’t entirely stop producing estrogen, says Susan M. Lark, M.D., director of the PMS and Menopause Self-Help Center in Los Altos, California, author of Menopause: Self-Help Book and a physician specializing in women’s health. Even after their ovaries stop producing estrogen, their adrenal glands and one small area of each ovary called the stroma continue to produce small amounts of this hormone. These glands don’t produce enough estrogen to promote menstruation, but they do produce enough to keep the most bothersome symptoms of menopause at bay, explains Dr. Lark.
“Some women are just good estrogen producers,” she says. “We don’t know why.”
The amount of estrogen that the body continues to produce is out of a woman’s hands, adds Dr. Lark. But there are plenty of other factors that a woman can control that can reduce menopausal discomfort. “Women who avoid stress, who don’t overdo caffeine and who get regular exercise have a much easier time of it than women who don’t do those things,” she says.
“There isn’t much hard evidence to prove it, but it has been my experience that women who have a history of premenstrual syndrome and bad menstrual cramps also have more hot flashes and other symptoms of meno pause,” says Dr. Lark. And here again, lifestyle factors come into play. “These women tend to have very stressful lives, poor diets and poor coping skills,” she maintains.
Finally, nutrition apparently plays an important role in determining whether your menopause will be an endurance contest or a walk in the park. Here’s what experts say you can do to make the transition as comfortable as possible.
| Fighting Back with Phytoestrogens If you're fed up with menopause, move to Japan. In the Land of the Rising Sun, hot flashes and night sweats are virtually unheard of. "Oriental women and American women report such dramatically different experiences of menopause that it's easy to wonder if we're talking about the same thing," says Margo Woods, D.Sc., associate professor of community health at Tufts University School of Medicine in Boston. Dr. Woods is researching the effects of soy on menopausal symptoms. Of course, Japanese women don't have an easier time with menopause just because of where they live. Researchers believe that it has more to do with their traditional diet. Besides providing more vegetable protein and less animal protein than a Western diet, it's also low in fat and high in soy products such as tofu. These foods are rich in plant compounds known as phytoestrogens, which seem to mimic some of the biological activities of female hormones. "Japanese women of all ages have lower estrogen levels than their American counterparts," says Dr. Woods. "At first we thought it was just because of their lower-fat, higher-fiber diet. Now it looks as if phytoestrogens might also play a role." While the phytoestrogen content of soy foods varies considerably from brand to brand, one or two servings of tofu, soybeans or soy milk a day is equivalent to the usual intake of the Asian population. It also contains approximately 35 milligrams of phytoestrogens, a reasonable goal to shoot for, says Dr. Woods. Japanese women eat from 2½ to 3½ ounces of tofu per day, says Dr. Woods. "If you are having hot flashes and night sweats and don't want to take hormones, I certainly think it would be worthwhile to try it. It can't hurt," says Dr. Woods. "Legumes, vegetables and soy foods are safe, nutritious and good for you, whether you're having hot flashes or not." |
Vitamin E Snuffs Out Hot Flashes
A hot flash—that sudden, intensely hot feeling in your face and neck that makes you wish for a walk-in refrigerator—can happen anytime, anywhere: at home, at work, while you’re driving in traffic or even while you’re sleeping.
Caused by hormonal surges, hot flashes usually last for three to five minutes, but they can feel like an eternity. Some women get flushed, sweat profusely and even have heart palpitations. Other women have flashes so mild that they barely notice them. About 80 percent of all women going through menopause have hot flashes at one point or another.
Studies show that thin women are more prone to hot flashes than heavier women. This is because even after the ovaries slow their hormone production, fat cells continue to produce small amounts of estrogen. So women with a lot of fat cells go through less drastic estrogen withdrawal than their leaner sisters.
While hot flashes can be relieved by hormone replacement therapy, there may be another, less drastic option: a daily vitamin E supplement.
Vitamin E can act as an estrogen substitute, explains Dr. Lark. Studies have shown that it can relieve hot flashes, night sweats, mood swings and even vaginal dryness. “Vitamin E is really an essential part of a supplement program for women during the menopause years,” she says.
If vitamin E is so effective, why hasn’t your doctor recommended it? Chances are she has never heard of it, or if she has, she’s waiting to see some hard scientific proof that it works. And sad to say, there isn’t any. While a number of studies were done in the 1940s on vitamin E and menopause, the connection hasn’t been investigated recently. A number of doctors who use nutritional therapies as part of their medical practices recommend it, however, and find that it often works.
If you get hot flashes and would like to try vitamin E, Dr. Lark recommends a fairly high dose: about 800 international units a day. And while vitamin E is nontoxic at this level, she says, women should get their doctors’ okay before taking this high amount, especially if they have diabetes or high blood pressure.
| Food Factors Menopause is an excellent time to take stock of your eating habits and make healthy adjustments, says Susan Lark, M.D., director of the PMS and Menopause Self-Help Center in Los Altos, California, author of Menopause: Self-Help Book and a physician specializing in women's health. The following simple changes, she says, can make a big difference in your health during menopause and in the years to come. Shake the salt habit. Eating too much salt can contribute to water retention, a common problem among women going through menopause, says Dr. Lark. "It's not enough to stop adding salt to your foods," she cautions. "I tell women to eliminate fast foods, salty snacks and other highly processed foods and to use garlic and herbs instead of salt in cooking." Switch to decaf. "A number of studies show that women who use caffeine have more hot flashes than those who don't," says Dr. Lark. Caffeine used in excess also increases anxiety, irritability and mood swings. It depletes the body's stores of the B-complex vitamins, explains Dr. Lark, which can be a real problem for some women during menopause. With all of these negative side effects, Dr. Lark recommends either dramatically cutting down on caffeine or eliminating it entirely. Because cutting out caffeine can cause withdrawal symptoms such as irritability and headaches, she suggests eliminating caffeine gradually. And don't forget that tea, Be a teetotaler. Alcohol depletes the body's B-complex vitamins, disrupts the liver's ability to metabolize hormones and can worsen hot flashes, says Dr. Lark. "Excessive drinking is also a risk factor for osteoporosis, which all menopausal women should be concerned about," she adds. If you can't cut out cocktails altogether, she suggests limiting yourself to one or two drinks a week. Eat more fruits and vegetables. Fresh produce is full of important vitamins and minerals, says Dr. Lark. And because they're low in fat and high in fiber, eating more fruits and vegetables can help prevent weight gain, a common problem for women of menopausal age, according to Dr. Lark. |
Reduce Bleeding with Nutrients
Many women approach menopause expecting menstrual flow to taper off and finally stop. But for a good percentage, periods during perimenopause are heavier than ever.
Besides the inconvenience—perimenopausal bleeding is often so irregular that women have to be prepared anytime, anywhere—frequent heavy bleeding can seriously endanger a woman’s iron stores, says Dr. Lark.
Heavy bleeding can be treated effectively with nutrients, says Dr. Lark. “Some studies have shown that besides replenishing the iron lost through bleeding, a daily iron supplement may actually reduce the amount that a woman will bleed during future periods,” she says.
Women with heavy bleeding also benefit from loading up on vitamin C and bioflavonoids, she says. Bioflavonoids are chemical compounds related to vitamin C; they’re found in many citrus fruits and included in many supplements.
“Both vitamin C and bioflavonoids reduce bleeding by strengthening the capillary walls, which are at their weakest just before and during the menstrual period,” says Dr. Lark. And since bioflavonoids have many of the same chemical properties as estrogen, they can also be helpful in controlling hot flashes, night sweats and mood swings. She recommends a daily supplement that includes at least 1,000 milligrams of vitamin C and 800 milligrams of bioflavonoids.
Because vitamin C helps the body absorb iron more efficiently, Dr. Lark recommends taking these two nutrients together. If you take a multivitamin/multimineral supplement, check to make sure that it contains both vitamin C and iron. Another option is to take an iron supplement, about 15 milligrams, with a glass of orange juice. If you have a juicer, juicing the white pulp of the orange along with the rest of the fruit guarantees an abundant dose of bioflavonoids, Dr. Lark adds.
B-Complex Battles the Blahs
Depression is also common around the time of menopause, though nobody knows for sure how much of it results from hormonal fluctuations and how much is triggered by the everyday stresses that women face at midlife.
Regardless of what’s causing it, emotional stress can deplete the body of B vitamins, leaving a woman feeling tired, anxious and irritable, says Dr. Lark.
“High levels of estrogen can also deplete vitamin B6 and cause depression,” says Dr. Lark. “Women who take the Pill or hormone replacement therapy sometimes have this, and some perimenopausal women go through a period of having very high estrogen levels.” B6 also plays an important role in helping the liver to regulate estrogen levels, says Dr. Lark.
Vitamin B6 should always be taken as part of the B-complex, says Dr. Lark. She suggests a B-complex supplement containing 50 milligrams each of thiamin and niacin and 30 milligrams of B6.
Coping with Surgical Menopause
While most women experience the gradual progression of natural menopause, others go through “the change” much more abruptly. Each year thousands of women undergo hysterectomy, the surgical removal of the uterus and sometimes the ovaries because of conditions as varied as pelvic infection, endometriosis and cancer.
In most cases, the woman’s ovaries are left intact; they continue to produce estrogen until the woman goes through normal menopause. But if a woman’s ovaries are removed along with her uterus in what is called a complete hysterectomy, she’ll experience surgical menopause, with the same symptoms as any other woman who is going through natural menopause.
Women who experience surgical menopause may actually have more severe symptoms because they go through menopause so abruptly, says Dr. Lark.
A woman who undergoes a hysterectomy can benefit from the same nutritional strategies that help women who are going through natural meno pause, says Dr. Lark. “As far as your body is concerned, it’s the same process,” she says.
| Prescriptions for Healing While scientific studies have yet to be done, a number of doctors have found that certain nutrients may help many women avoid problems as they go through menopause. Here's what these doctors recommend. Nutrient Daily Amount
B-complex supplement containing . . .
Niacin 50 milligrams thiamin 50 milligrams Vitamin B6 30 milligrams Iron 15 milligrams Vitamin C 1,000 milligrams Vitamin E 800 international units
MEDICAL ALERT: If you're considering taking vitamin E in doses that exceed 600 international units a day, you should discuss it with your doctor first. If you are taking anticoagulant drugs, you should not take vitamin E supplements. |
