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Health
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Change In Part I we examined the physiological and psychological changes that accompany the menopausal transition. Without question these changes can be uncomfortable and can sometimes undermine a woman’s health. ...
In Part II, we’ll look at some of the preventive and therapeutic approaches to menopause. But let’s start by reviewing what our bodies naturally do to mitigate the effects of menopause. Inner hormone
replacement Northrop believes that “adrenal health” can help reduce menopausal symptoms and recommends stress management, reduction of sugar and caffeine and vitamin supplements to support adrenal function. Adrenal production will also continue to diminish with aging, but later and more gradually than ovarian production. The role of exercise A 1998 Swedish study published in Maturitas found that “fewer physically active women had severe vasomotor symptoms,” in other words, hot flashes. They theorized that “physical exercise on a regular basis affects neurotransmitters which regulate central thermoregulation.” It’s been widely accepted that weight gain is a symptom of menopause, but a recent study published in Menopause 2000 by New England Research Institutes challenges this assumption. This finding suggests that exercise can also address the weight gain experienced by many menopausal women. Nutrition This same study found that salt and protein increased the loss of calcium from bones. “Protein is another negative risk factor; increasing animal protein intake from 40 to 80 g daily increases urine calcium by about 1 mmol/day. Low protein intakes in third world countries may partially protect against osteoporosis." But other studies, of course, are contradictory. A study published in American Journal of Clinical Nutrition [1999] concluded that “Intake of dietary protein, especially from animal sources, may be associated with a reduced incidence of hip fractures in postmenopausal women.” Good nutrition guidelines for overall health apply to menopausal women as well. Smoking and excessive alcohol consumption increase the risk for osteoporosis as well as other illnesses. And the fruits and vegetables that are thought to help prevent some cancers, heart disease and diabetes have been shown to improve bone health also Herbs Black cohosh is one herb that has been studied. In her Use of Alternative Medicine in Women's Health, Lynn Limon explains, “Triterpene glycosides or saponins, including the xylosides actein, 27-deoxyactein, and cimicifugoside, are the primary active constituents of black cohosh and are found in the rhizome and root. It has estrogen-like action and is a progesterone precursor. Clinical data support the use of black cohosh for menopausal problems for at least 6 months” Healthnotes, an online site providing information about complementary medicine reports, “German clinical studies support the usefulness of black cohosh for women with hot flashes associated with menopause. A review of eight trials concluded black cohosh to be both safe and effective. Recently, a clinical study compared the effects of 40 mg versus 130 mg of black cohosh in menopausal women with complaints of hot flashes. While hot flashes were reduced equally at both amounts, there was no evidence of any estrogenic effect in any of the women. Black cohosh is therefore reserved only for the symptomatic treatment of hot flashes associated with menopause and is not thought to be a substitute for hormone replacement therapy in menopausal and postmenopausal women.” Limon adds, “Adverse effects of black cohosh include nausea, vomiting, dizziness, nervous system and visual disturbances, and reduced heart rate. Because it contains salicylic acid and an anticoagulant, black cohosh may interact with salicylates or salicylic acid-containing herbs and any anticoagulant-containing substance and can cause increased bleeding or affect platelet aggregation.” Like prescription drugs, then, herbal medicines should be taken under the guidance of a qualified healthcare provider. Plant
estrogens Healthnotes reported, “In one double-blind trial, 60 grams of soy protein caused a 33% decrease in the number of hot flashes after four weeks and a 45% reduction after 12 weeks. However, in further analysis of the data in this trial, researchers now believe constituents in soybeans other than phytoestrogens must have been responsible for the therapeutic effect. Double-blind evidence from other researchers has also shown significant reduction in the number of hot flashes. In one randomized trial, high intake of phytoestrogens from soy and flaxseed reduced both hot flashes and vaginal dryness, but much (though not all) of the benefit was also seen in the control group." In "Phytoestrogens as Therapeutic Alternatives to Traditional Hormone Replacement in Postmenopausal Women," the authors conclude that there is no evidence to show that phytoestrogens reduce cardiovascular disease or osteoporosis in a “manner comparable with HRT." (hormone replacement therapy). But they do say, “Human data regarding the hormones' ability to alleviate menopausal symptoms, their potential reduction in breast cancer risk, and potential increase in BMD are positive. These compelling data, in conjunction with absence of information regarding dosing and long-term effects, should serve as stepping stones for further research evaluating phytoestrogens as alternatives or adjuncts to conventional HRT." Complementary therapies Acupuncture, for example, has been used traditionally to treat symptoms of menopause. The National Institutes of Health indicates at its Complementary Medicine site that the World Health Organization has listed menopause as one of the 40 conditions that may be treated by acupuncture. Yoga has also been used therapeutically to address menopause symptoms. Yogic breathing techniques address hot flashes as well as providing stress reduction. The Canadian Consensus Conference on Menopause and Osteoporosis agrees that, “Both regular aerobic exercise and deep breathing exercises (slow-paced respiration at six breaths/minute) may result in a 40 to 50% reduction in hot flushes." Because yoga postures are thought to affect both the nervous and the endocrine system, yoga may be used to alleviate perimenopausal anxiety and sleep disturbances and to strengthen adrenal function. Hormone
replacement As we learned in Part I of this article, some symptoms of the menopausal transition are simply uncomfortable, some may undermine quality of life and some may. undermine health and longevity. Cardiovascular disease is the number one cause of death in women in this country. It had been thought that replacing estrogen would prevent cardiovascular disease, but more recent studies have clouded this issue. Desiree Lie, M.D., reports in her comprehensive Hormone Replacement Therapy: Current Evidence and Practice, “More than 30 observational studies (the majority but not all) have reported that ERT or cyclic HRT is associated with a reduced risk of coronary heart disease (CHD) in postmenopausal women. The clinical implication of these studies is that HRT may be effective for primary prevention of CHD in menopausal women." A recent large study (the HERS study) shows an increase in secondary “cardiovascular events” like heart attacks in women taking HRT. Dr. Lie says that, “…HRT is associated with an increase in the frequency of cardiac events during early months of treatment, followed by a reduction in incidence over the long term." HRT has been associated with an increased risk in uterine and breast cancer. Combining progestin with estrogen is thought to reduce the risk of uterine cancer, but not breast cancer. “A number of recent studies on combination therapy provide evidence that the addition of progestin to estrogen does not reduce and may even increase the risk of breast cancer,” says Lie. She has found that, “A significant amount of data supports an increase in breast-cancer risk with long-term hormone use. Recently, a large epidemiologic study revealed a trend of increasing breast-cancer risk with duration of HRT use in women.” Preliminary research in HRT use has suggested that estrogen replacement may help prevent Alzheimer’s disease and even diabetes, as well. And estrogen applied as a vaginal cream has been shown to effectively treat vaginal atrophy and associated urinary tract infections and, perhaps, postmenopausal urinary incontinence. Probably the most important concept to take away from the extensive and often confusing information on HRT is that studies continue to challenge previously held assumptions and that HRT is becoming a more and more finely tuned therapy. Just as each woman has her own, unique physiological and psychological response to the menopause transition, each woman also has her own set of health risks and strengths that figure into the decision about HRT. Is
knowledge power? But this is an era in which scientists have begun to decipher the genetic code. What was unimaginable to our grandmothers is now commonplace. We can even ask, “Can medicine slow down or prevent aging?” We have options. And with those options come not only risks, but fundamental questions.
Medicine in this country may be scientific, but it isn’t necessarily objective. When we hear the results of research, it’s important to identify the questions that the research answers. Who was looking for what ... and why? In that light, scientific knowledge can be power only when it comes along with a willingness to question. Every woman knows her own body in her own way. That is a different kind of knowledge, and that knowledge can be power, too. Laura Wisniewski . ******* ******* If you would like to submit something for our Health & Med section, don't hesitate to let us know. Simply e-mail us at health@downstreetmagazine.com. The e-mail should contain your name, address, and a phone number where we can reach you. You may also send a copy of your proposed article. The text can either be included in the body of the e-mail, or you can send it as an attachment in just about any word processing format. If your piece is accepted, we will pay a small honorarium for your interest & your time. [See Freelancers Wanted for more details.] ******* ******* If you would like to advertise in this section, or throughout the magazine, please visit our Advertising Info Pages ... or call, write, or e-mail ads@downstreetmagazine.com. ******* ******* |
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