Menopause

Progesterone and menopause are inextricably linked at many levels. Strictly speaking menopause only occurs when periods have finally stopped. It is generally recommended to allow a year to pass before drawing this conclusion. The symptoms which can be experienced in the years before its onset (sometimes referred to as peri-menopause) are generally far worse than those following after. In some women symptoms can start ten years before, sometimes they can persist from 5 to 10 years after.

For a comprehensive list of menopause symptoms please click here.

The causes of menopause...

Natural causes

Menopause normally occurs at an average age of fifty-one. Some women can reach their early sixties, whilst the youngest on record is nineteen. Smoking can reduce the age it begins by two years. An early puberty usually means a late menopause, but many factors can influence it’s start.

Women are born with a finite number of eggs, all fully developed whilst she is still a foetus, peaking at several million. The current theory as to what causes menopause is that as a woman ages, the number of eggs declines and the ovaries shrink. At menopause, there are only about 1,000 left. But it is still only a theory, no one knows for sure.

At puberty the child starts developing into a woman. This is controlled by the affect of the two sex hormones estrogen and testosterone. Estrogen causes the breasts to grow and fat to be deposited, especially on the hips and thighs. Too much can cause a child to have very large breasts and fats deposits, causing the well known ‘puppy fat’. One of the main reasons for puppy fat is a lack of progesterone, which opposes the action of estrogen, but not until ovulation occurs is this produced. Once ovulation starts the puppy fat generally goes. Testosterone increases libido, deepens the voice and causes body hair to grow. But too much can cause aggression, acne, large quantities of body hair and contribute to poly-cystic ovaries. Women produce about 80% less testosterone than men.

About two years after the onset of puberty menstruation begins. The cycle is governed by four hormones. Initially follicle stimulating hormone (FSH) stimulates the egg, and the follicle surrounding it, to grow and the ovary to make estrogen. Estrogen is the dominant hormone in the first half of the cycle, stimulating the buildup of tissue and blood in the uterus.

At mid cycle the pituitary gland produces luteinising hormone which stimulates the follicle to rupture, releasing the egg, which slowly makes it’s way down the fallopian tube. The ruptured follicle, now called the corpus luteum, starts producing progesterone, the dominant hormone in the second half. Progesterone readies the endometrium (the uterine lining) for pregnancy. If the egg is fertilized it embeds itself in the lining and pregnancy ensues. If not, then the levels of both estrogen and progesterone drop sharply causing the lining to be shed.

This cycle continues until about ten years before menopause, when anovulatory (no ovulation) cycles begin. This is when the significance of the relationship between progesterone and menopause becomes apparent. When the anovulatory cycle happens no progesterone is produced during that month, but estrogen is still being made, leading to symptoms of estrogen dominance. Please refer to the above list for possible symptoms. As menopause approaches, anovulatory cycles increase, which in turn increases the amount and severity of the symptoms. By menopause the progesterone level can be as low as those in a man, but estrogen levels only drop when it finally arrives. Despite this women are often told the adverse symptoms which they've been experiencing are due to a drop in the estrogen level!

The link with progesterone is highlighted by the fact that women in industrialized countries have a hard time compared to women in rural societies. Dr. P. Ellison of Harvard University has studied estrogen levels in various ecological and cultural populations and has found that estrogen levels in western women are abnormally high. This can be due to a number of factors:

• the food we consume (particularly animals fed estrogen to fatten them)
• the crops sprayed with pesticides (most of which are estrogenic)
• the Pill and HRT
• drinking recycled water which has not had the estrogen removed
• using cosmetics which are made with liquid paraffin and estrogenic antioxidants

Many women are under great stress during peri-menopause having to juggle work and home, often a teenage daughter is going through puberty at the same time, children leaving home, a bad marriage, job difficulties and maybe elderly parents now need looking after.

An understanding of the effects of a lack of progesterone is key to undestanding that progesterone can play an enormously beneficial role in helping to go through menopause without too many adverse affects. By naturally opposing the action of estrogen, the symptoms of estrogen dominance are lessened and in some cases eliminated. The easiest method to apply progesterone is in a cream form.

New research conducted by Wallace and Kelsey and published in "Human Reproduction", indicates that it might be possible, using ultrascan on the ovaries, to show the approach of menopause. Currently blood hormone levels are used to try to determine this, but these are notoriously inaccurate as it is common practice to only check estrogen levels, not progesterone. The patient generally needs to specifcally request this despite the fact that progesterone and menopause are inextricably connected. As the symptoms of menopause are caused by a lack of progesterone and too much estrogen, the standard "estrogen only" test is of little help.

Menopausal women are actively encouraged to have Pap smears, mammograms or have a doctors examination on a regular basis. These have not been shown to reduce deaths from cancer, but merely enable earlier detection and treatment. (Please see page on cancer). Dr. P. Ellison suggests that the abnormal levels of estrogen in western women may be related to the current epidemic of breast and ovarian cancers.

Chemical causes

Menopause can be precipitated at any time in a woman’s life by chemotherapy used in cancer treatments. The symptoms are the same as in natural menopause. Tamoxifen, the chemical used to control breast cancer, can cause severe hot flushes. Progesterone can be safely used to combat them.

Hysterectomy

By removal of the uterus and possibly the ovaries, a woman is in instant menopause. If the ovaries are not removed at the same time as the uterus, they will generally atrophy within two to three years. In the recent past, following a hysterectomy, women were usually given HRT. However, with the publication of studies finalized in 2004, which proved beyond doubt that HRT can cause an increase in cancer (particularly breast cancer), stroke and heart disease, this practice has declined. Unfortunately few medical practitioners recommend progesterone regardless of the clear connection between progesterone and menopause.

Causes of Premature menopause

For reasons not too clear some women can go into premature menopause. One possible theory is the affect xeno-estrogens (xeno means foreign) have on the developing foetus. Xeno-estrogens mimic natural estrogen, but are extremely potent and highly toxic. Early exposure to estrogen or the xeno-estrogens can cause the follicles to mature rapidly and die off leaving few eggs in the ovary to reach puberty. This in turn leads to early menopause. Please visit the recommended web sites below for more on xeno-estrogens.

Turners’ syndrome (TS)

Mention must be made of the 1:2000 girl babies born with TS. Again for reasons unclear, these children are born with an X chromosome either missing entirely or partially missing. Apart from many potential problems, they have non-functioning ovaries, which means no estrogen will ever be produced. So as the child approaches puberty, the lack of secondary sexual characteristics becomes apparent, no breast, thighs etc. develop. She is then given supplemental estrogen to correct this, but no progesterone to balance the estrogen. Unfortunately, under the misguided belief that estrogen prevents osteoporosis, (please refer to the page on osteoporosis), she is often put onto HRT. As TS was first reported as recently as the 1930's, it is possible that environmental poisons are to blame.

Now the all important question...

How to alleviate the symptoms of menopause? There are two principal lines of approach...

First, Diet

The "Metabolic Typing Diet" is an excellent means of obtaining lasting health. The diet is the product of many years of detailed research and looks at the many ways the body metabolizes food. It is based on the obvious but hitherto little understood fact that each individual has a unique metabolism. ‘Metabolic Typing’, as the name suggests, is an analytical process that defines each individual’s unique nutritional requirements by determining how they metabolize food and categorizes a person according to their needs.

Stabilizing blood sugar is imperative. Hot flashes can be caused by too much sugar. Small frequent meals are often a help for blood sugar imbalances. After a large meal there is a temporary drop in the level of progesterone, due to an increased metabolic clearance rate of that hormone, so symptoms can become worse for a while. Food should be natural and unprocessed and include both protein and fibre, particularly the gel forming fibre such as apple pectin, guar gum, xanthan gum, unrefined buckwheat and oat bran as these have been shown to stabilize blood sugar. As a substitute for sugar use either xylitol, stevia or fructose. Stevia is a natural extract from the plant Stevia rebaudiana, a member of the daisy family, native to Paraguay. The extract is 200-300 times sweeter than sugar, but has none of the drawbacks and does not affect blood sugar in any way. The fresh or dried leaves are easier to use and taste better. Another option is xylitol, a natural sweetener which looks and tastes like sugar, but is metabolized by the body at a much slower rate, it has 2.4 calories per gram. A beneficial affect is its ability to reduce dental caries, its one drawback is its high cost. Although fructose is a processed food, and its intake should be limited, it does not cause a blood sugar spike, as it is ranked 20 on the "Glycaemic Index".

Avoid:

• sugar and all forms of processed foods containing sugar
• refined grains, particularly wheat
• carbonated drinks, including the ‘diet’ drinks
• biscuits; cakes; white breads
• canned foods; sauces; sweets
• large meals
• all forms of estrogen
• oxidized fats, i.e. margarine, refined oils, saturated fats and fried foods, in particular fried animal protein
• non organic milk
• stimulants such as coffee, black tea.

Read all labels on containers, especially those for food and cosmetics. Look for natural alternatives to body care products, many contain high levels of endocrine disrupters and carcinogens. Processed food contains preservatives, colorants, flavourants, sweeteners. Especially avoid the sweetener "aspartame" as it is known to cause lupus and epilepsy. Avoid fluoride, long term exposure causes brittle bones. The bi-phosphonate drugs result in an increase in fracture, whilst damaging the oesophagus. Use natural alternatives to household cleaners, which are some of the most toxic chemicals we regularly come into contact with. Avoid golf courses, especially when fertilizing or spraying, a higher level of chemicals are used on them than on farms.

References

• BMJ 2004;328:E301-E302 (12 June), doi:10.1136/bmj.328.7453.E301, Editorial ‘Balancing mammography's benefits and harms’
• J Natl Cancer Inst 1998;90: 906-910. White E, Velentgas P, Mandelson MT, Lehman CD, Elmore JG, Porter P, et al. ‘Variation in mammographic breast density by time in menstrual cycle among women aged 40-49 years.’
• BMJ 2003;327:12 (5 July), doi:10.1136/bmj.327.7405.12-e. Hazel Thornton, Adrian Edwards, Michael Baum, ‘Women with dense breast tissue need both mammography and ultrasonography to detect tumours’
• BMJ 2003;327:101-103 (12 July), doi:10.1136/bmj.327.7406.101 Judy Siegel-Itzkovich ‘Women need better information about routine mammography’
• Human Reproduction, Vol 8, 2248-2258. PT Ellison, C Panter-Brick, SF Lipson and MT O'Rourke. ‘The ecological context of human ovarian function’
• Human Reproduction ,19, 1613 -1618 , (2004). Wallace, H. W. & Kelsey, T. W.

Recommended Web sites for environmental poisons and xeno-estrogens

Chemical Body Burden
Organic Consumers
Our Stolen Future
Panna
The Worldwatch Institute

Recommended reading

• Balch & Balch, Prescription for Nutritional Healing
• Lee, John, M.D., What your Doctor may not tell you about Menopause
• Coney, Sandra, The Menopause Industry
• Kenton, Leslie, Passage to Power - Natural Menopause Revolution
• Sheehy, Gail, The Silent Passage

Here's something that may interest you if night sweats are a problem Menopause (peri-menopause)

For more information on menopause symptom relief products click here.

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