THE MENOPAUSAL TRANSITION (The Season of Fall) (Natural Hormone Therapy)
THE MENOPAUSAL TRANSITION
Menopause marks the end of a woman’s fertile years. The official transition into menopause is marked exactly at one year after a woman’s last period. Menopause occurs when the ovaries cease to produce oestrogen and progesterone, and eggs are no longer released from the ovaries. Perimenopause may starts as early as 10-12 years prior to menopause. On average, women experience menopause at age 50-53. However, menopause can occur as early as 40, or even as late as in your mid-fifties. In today’s society almost 90% of women experience symptoms (more and less severe) related to menopause, and only about 10% of women go through peri-menopause and into menopause with no symptoms. For women who have had hysterectomies, menopause tend to occur a little earlier (a few years), though in the case of an oophorectomy (removal of ovaries) the woman enter menopause immediately, no matter her age.
Though we may have strayed far from this viewpoint in the west, Ayurveda and Traditional Chinese Medicine recognize menopause as a potent time where a profound energy shift takes place; traditionally celebrated as a time of deepened wisdom and with a different outlook on life.
THE THREE GOLDEN OPPORTUNITIES
Chinese Medicine teaches about ‘The Three Golden Opportunities’ These are particular times in women’s lives where there is the potential of either depletion or replenishment and rejuvenation. How these events are navigated sets the stage for both short term and long term health.
The Three Golden Opportunities are:
1. Menstruation
2. Postpartum
3. Perimenopause and menopause
The Three Golden opportunities are invitations for woman to deepen her understanding of Self. During the menopausal transition, a woman has the opportunity to set the stage for the second half of her life.
There’s a traditional Native American saying that goes something like this; “When a woman enters menarche she meets her power. Through her menstruating years she practices her power. When a woman reaches menopause she becomes her power.”
~ Part of the menopausal woman’s journey is to understand why she does things the way she does. It is a time to build resilience through understanding her default behaviors and gain deeper insight and deepened self-awareness.
THE THREE PHASES OF LIFE
Ayurveda recognizes three primary stages of life, childhood, adulthood, and elderhood. Each stage is associated with one of the three doshas, which again is related to the elements.
Childhood (Brahmacharya Ashram) is generally thought of as a time of growth, building, and learning. Ayurveda associates this stage of life with the elements of Earth and Water, and the Kapha dosha.
Adulthood (Grihastha Ashram) is considered a time of accomplishments and creating a home/base/family. It is associated with the element of Fire and Water, which is the Pitta Dosha.
Elderhood (Sannyasa Ashram), has traditionally been viewed as a period of letting go of the need to achieve, and settling into your wisdom. It is associated with the elements of air and ether, and the Vata Dosha.
“The years of a woman’s life beyond the transformations she undergoes in menopause see a divine establishment in her maturation of self. As the vata phase of life becomes dominant, the ageing forces prevail. A woman is anchored by the mineral forces of her body and illuminated by the light of spiritual orientation so active by nature.. the light within grows stronger and brighter. This is, of course, when a woman allows such light to organically, without resistance, illuminate her emergence as the elder.” ~ Dipika Delmenico
As a woman enter menopause, she simultaneously enters into her “Vata” season of life, which coincides with Autumn in the yearly cycle, and the early morning of 2am to 6am in the circadian cycle. Physically, we often see the Vata qualities manifested in people through a thin frame, fine features, dryness and coldness. Later in life we see Vata expressed in a more frail body, dryer and thinner skin, vaginal dryness, thinning of the hair, etc. Depending on how well we manage Vata, these changes may be more or less prevalent.
The most common symptoms of menopause can be seen in relation to the seventh tissue state in ayurveda, which we know as the shukra dhatu. Therefore, we need to ensure that this tissue, the deepest tissue layer related to the reproductive system, is nourished and replenished.
To balance the increased levels of Vata energy, (or kidney yin deficiency in TCM) we look to invite in that which is warm, moistening and grounding. This can be seen as Yin qualities in TCM, and as the Kapha Dosha (Earth and Water) in Ayurveda. Vata is balanced by warmth, but we need to be careful when adding heat, as too much heat can easily aggravate Vata further, by increasing dryness.
HEAT ACCUMULATION
Living a fast-paced life in the western world can contribute to what we call heat in the body. This can be attributed to our diet, lifestyle and emotional factors.
From both Chinese medicine and Ayurveda, we know that having a monthly period allows the body to clear itself of excess heat. When menopause approaches and periods become irregular, this release of heat is no longer as consistent. Because of this, the body finds other ways to clear yang-induced heat. One of the primary ways the body clears heat is through the skin, and this is why many of the menopausal symptoms are largely skin and heat-related. Chinese medicine teaches that hot flushes, thinning hair, vaginal dryness and osteoporosis are all signs of too much heat in the body.
YIN DEFICIENCY AND INCREASED VATA
As mentioned above, as you move through peri-menopause, you enter into the Vata, or “Autumn” stage of your life. Here, the element of Air and Ether are predominant. What this means is that you will easily have too much of these qualities, which can lead to problems such as dryness (skin, bones, vaginal), anxiety, sleep disturbances and a foggy mind, as well as arthritis, osteoporosis and other degenerative diseases down the line. Through attention to diet, lifestyle, supportive practices and a good environment, we can help to reduce the amount of heat that is produced in the body, whilst balancing the Vata energies. Generally, a good place to begin is your diet.
Dietary considerations for the menopausal transition, and beyond!
Focus on a whole-foods based diet, rich in fresh fruits and vegetables.
Ensure regular mealtimes, and meals eaten in a calm, relaxed environment.
Eat your biggest meal for lunch
Include foods containing cholesterol. Cholesterol (which is of concern mainy when it is oxidized according to Dr. John Lee) is a precursor for progesterone, estrogen, DHEA and other hormones. When cholesterol is eaten alongside plenty of antioxidants, there should be no problem.
Include spices to support digestion such as ginger, cumin, coriander, fennel, turmeric, cardamom and cloves
Include foods that nourish your bone marrow including almonds, pistachios, coconut, ghee, pumpkin, sesame seeds & raw dairy
Avoid coffee and limit other foods high in caffeine (black tea, cacao, chocolate)
Focus on healthy and nourishing fats such as ghee, organic butter, coconut, soaked nuts and seeds, avocados, raw dairy, olive oil and olives
Eat mostly warm meals and drinks. Herbal teas, broths, nourishing elixirs and soups are golden.
Other supportive practices to bring balance during peri menopause and after menopause:
daily warm oil massage with sesame oil, followed by a warm shower or bath after your massage.
Warm up a small amount of sesame oil and massage it onto your kidney area for added kidney support.
Implement rest and quiet and spend time in nature
Movement and exercise, ideally some every day. Weight bearing exercises for menopausal women is highly valuable in the prevention of both bone loss and muscle mass loss.
Find an experienced, holistic practitioner who can help you with diet, herbal remedies, etc.
Herbal support
Herbal remedies may be prescribed for a number of conditions and reasons. These herbs and remedies will be recommended to support your unique symptoms & constitution. Please remember the importance of seeking professional help- and do not self-prescribe. Herbs, such as wild yam, contains a natural form of progesterone that can be applied topically and taken internally when added progesterone is seen to be beneficial.
Generally, herbs and herbal remedies that work on strengthening and rejuvenating the female reproductive system, as well as those that help to regulate the hormones and calm the emotions, are indicated for the menopausal transition. Herbs that penetrate and break up any stagnant layers may be prescribed to reduce toxins. There is also a variety of herbs available that can be added to your daily regime for overall support of your mineral balance, to replenish depleted reserves, boost your immune system and aid in overall health and wellbeing, including herbs that have nutritive, calming and troporestorative qualities.
A note on HORMONE REPLACEMENT THERAPY?
The topic of Hormone Replacement Therapy is a vast one, and I will only briefly discuss it here.
Most of the symptoms associated with menopause are attributed to the declining levels of the hormones estrogen, progesterone and androgens (including testosterone). Symptoms may occur due to a rapid withdrawal, as well as an imbalance between estrogen and progesterone levels. More and more research has been proven to show that it is primarily the decrease in progesterone that is causing the majority of menopausal symptoms.
Today, hormone replacement therapy (HRT) is the most commonly prescribed treatment for pretty much any issue related to the menopausal transition, as well as for the prevention of bone loss (osteoporosis) which we know to be directly linked to changing hormonal levels.
HRT may help to relieve women from their symptoms, but unfortunately it does come with a cocktail of associated risks and side effects. Ever since HRT became available on the market, the supplementation of particularly estrogen (estrone and estradiol), and sometimes, with progestin/progestogen has been used for complaints related to the menopausal transition (with variable levels of success).
When HRT is necessary, it should be used with caution for the shortest period required, at the lowest possible dose. Studies show that HRT has been linked to diseases such breast cancer, venous thromboembolism and heart attack. Even short-term use can cause side effects including weight gain, sore breasts, increased blood pressure, vaginal bleeding, , nausea and vomiting.
NATURAL HORMONE REPLACEMENT THERAPY
Some women journey through perimenopause without needing additional hormone support, and in an ideal world, it would not be necessary at all as we would be more attuned to our bodies and the natural world. It is important we remember that menopause is a natural process, not a medical event requiring medication. Menopause is not a condition or disease!
However, today many women enter perimenopause feeling exhausted, suffering from sleep deprivation, nutritional deficiencies, low energy, low libido, vaginal dryness, painful intercourse, headaches, and a host of other uncomfortable menopausal symptoms. This may be attributed to the fact that their bodies lack the raw materials to produce adequate hormones (which is really the first area we should look into).
The hormone progesterone is made by the ovaries, and in smaller amounts by the brain and by some nerve cells. Most forms of hormone replacement therapy do not include natural progesterone, but instead something known as medroxyprogesterone acetate, MPA or progestin/progestogen (not bio identical). This is a synthetic, human made compound mimicking the effects of progesterone. Often, HRT consists of estrogen only. This is concerning due to a number of reasons:
“The emerging realization that estrogen should never be given unopposed, i.e., without progesterone, due to its risk of developing endometrial carcinoma makes natural progesterone a valuable addition in those cases where menopausal symptoms require treatment… It is amazing to me that, given the extensive supporting medical references presently existing, estrogen without concomitant progesterone is still commonly prescribed”: - John Lee, M.D
Just as some women might be best off with no supplemental hormones, others might need support. More and more research shows us that natural hormone therapy, particularly with natural progesterone, can be immensely beneficial for women. It can also be used to prevent the development osteoporosis, which unfortunately, for a long time was an action attributed to estrogen:
Dr. Lee quoting the 1991 Scientific American Medicine in the book “The Estrogen Alternative”
“Estrogen decrease bone resorption” but “associated with the decrease in bone resorption is a decrease in bone formation. Therefore, estrogens should not be expected to increase bone mass”. The authors also discuss estrogen side effects including the risk of endometrial cancer which “is increased six-fold in women who receive estrogen theraphy for up to five years; the risk is increased 15-fold for long term users”.
“One of the first things women ask is whether there are any adverse side effects with natural progesterone. All of my investigation says there have been no negative results- only positive. In fact, Dr. Niels Lauersen tells us: “Progesterone is not believed to me cancer causing. No human cancer has been reported during progesterone treatment; quite the reverse, progesterone has been used in treating specific uterine cancers.”” Excerpt from the book “The Estrogen Alternative” by Raquel Martin and Judi Gerstung M.D.
There is much more to say on the topic of HRT and Natural Hormone Therapy. The most important notion I wish to make here is that there are alternatives to manufactured hormones that are far less dangerous. Natural progesterone has proven to be useful in treating a variety of issues including PMS, infertility, menstrual irregularity, endometriosis, uterine fibroids, menopausal symptoms and discomforts and osteoporosis.
Summary
As you continue into menopause and beyond, your body will produce less hormones, this is a completely natural part of life. Your yin energy reserves will be decreasing, and the elemental forces of Air and Ether will become more dominant during this time of life.
If no considerations are taken, this can manifest in uncomfortable symptoms, a weakened constitution and an overall lower quality of life. Luckily, there are many things that can be implemented to make menopause a beautiful and enjoyable time of your life. A time where you can sink into your heart, deepen into your wisdom and enjoy all the gifts that this particular time of life has to offer. Attention to your diet, getting enough yin-based nourishment, implementing rest, and reducing stress are perhaps some of the most effective remedies that will have long-lasting results. Natural progesterone support can be of great benefit, whether or not you are suffering from symptoms.
How you care for yourself in the years of perimenopause and beyond will impact the quality of rest of your life. Considering that if you live to be 100 years old, this is actually half of your life.
“According to Chinese and ancient Ayurvedic medicine, at age 60, women end their householder life and begin to develop their souls. Our fertility stops being about having children and starts being about what we create for ourselves that benefits us and the people around us.”
― Christiane Northrup